1^  a  GD  ^ 


S?^ 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Boston  Library  Consortium  IVIember  Libraries 


http://www.archive.org/details/kingdomofevilspsOOsout 


THE  KINGDOM  OF  EVILS 


f^^^ 


THE  MACMILLAN   COMPANY 

NEW  YORK   •    BOSTON'  •     CHICAGO   •    DALLAS 
ATLANTA    •    SAN    FRANCISCO 

MACMILLAN  &   CO.,  Limited 

LONDON   •    BOMBAY    •    CALCUTTA 
MELBOURNE 

THE  MACMILLAN  CO.  OF  CANADA,  Ltd. 

TORONTO 


THE   KINGDOM    OF    EVILS 

Psychiatric  Social    JVork   Presented  in   One   Hundred   Case  Histories   To- 
gether with  a  Classification  of  Social  Divisions  of  Evil 


BY 

E.    E.    SOUTHARD,    M.D. 

Late    Bullard    Professor    of    Neuropathology,    Harvard    Medical    School;    Pathologist 

Massachusetts  Commission  on  Mental  Diseases;  Director,  Boston  Psychopathic 

Hospital;  President,   American   Medico-Psychological  Association 


MARY    C.    JARRETT 

Associate  Director,   Smith   College  Training  School  for   Social  Work;   formerly   Chiei 
of  Social  Service,   Boston  Psychopathic   Hospital 


WITH    AN    INTRODUCTION    BY 

RICHARD  C.  CABOT,  M.D. 

Professor  of  Social  Ethics,  Harvard  University 
AND 

A  NOTE  UPON  LEGAL  ENTANGLEMENT 
AS  A  DIVISION   OF  EVIL    BY 

ROSCOE  POUND 

Dean  of  the  Harvard  Law  School 


BOSTON  COLLEGE  LI  BRAKY 
CHESTNUT  HILL,  MASS. 

THE  MACMILLAN  COMPANY 
1922 

All  rights  reserved 


PRINTED   IN   THE   UNITED  STATES  OF   AMERICA 


Copyright,  1922, 
By  the  MACMILLAN  COMPANY. 


Set  up  and  printed.     Published  October,   1932. 


Press  of 
J.  J.  Little  &  Ives  Company 
New  York.  U.  S.  A. 


14 


To 

The  Memory  of 

JOSIAH  ROYCE 

WHOSE    WORK    ON 

THE   SOCIAL   CONSCIOUSNESS 

THE  PROBLEM  OF  EVIL  AND 

THE    PRINCIPLES    OF    ORDER 

HELD  OUR  OWN   WORK 

IN  SOLUTION. 


PREFACE 

The  writing  of  this  book  had  been  completed,  with  the  excep- 
tion of  a  few  passages,  and  the  form  of  it  had  been  planned 
before  Dr.  Southard's  sudden  death  from  pneumonia  in  Feb- 
ruary, 1920.  He  had  said  that  he  would  do  no  more  work 
upon  it  after  February  first,  for  one  might  continue  indefi- 
nitely to  elaborate  a  book  such  as  this.  We  felt  that  its  chief 
value  would  lie  in  the  suggestiveness  of  the  ideas  presented  and 
not  in  their  completeness.  It  was  not  intended  that  the  book 
should  be  either  a  treatise  or  a  text-book,  but  a  record  of  ex- 
perience with  comment.  Such  a  work  might  serve  several 
purposes, — to  suggest  ideas  to  social  workers,  to  reveal  to  other 
professional  persons  the  nature  of  social  work,  and  to  throw 
light  upon  the  problems  of  mental  hygiene  for  all  persons  inter- 
ested in  human  life.  Mr.  Pound  has  said  that  "it  is  a  book 
to  quarry  in." 

Among  the  passages  that  Dr.  Southard  had  not  written  were 
some  on  medical  subjects,  which  his  friend.  Dr.  Harry  C. 
Solomon,  was  kind  enough  to  write  in  accordance  with  views 
held  by  Dr.  Southard. 

The  cases  were  not  chosen  as  examples  of  successful  social 
work,  but  were  selected  because  they  were  believed  to  be  in- 
structive, whether  by  reason  of  success  or  failure. 

The  work  of  the  social  service  of  the  Psychopathic  Hospital 
during  the  period  that  this  book  records  was  the  sum  of  much 
earnest  and  thoughtful  effort  on  the  part  of  many  workers, 
assistants,  students,  and  volunteers,  to  whom  I  wish  that  I 
might  make  personal  acknowledgment  at  this  time.  Among 
the  assistant  social  workers  who  had  most  to  do  with  the  de- 
velopment of  the  work  were  Mrs.  Helen  Anderson  Young, 
Mrs.    Maida   H.    Solomon,    Miss    Helen   Wright,   and   Miss 


viii  PREFACE 

Dorothy  Q.  Hale.  Among  the  physicians  who  helped  most  to 
develop  the  social  work  of  the  hospital  were  Dr.  Herman  M. 
Adler,  Dr.  A.  Warren  Stearns,  Dr.  Abraham  Myerson,  Dr. 
Frankwood  E.  Williams,  and  Dr.  Harry  C.  Solomon. 

Mary  C.  Jarrett. 
Boston, 

July  22,,  1922. 


INTRODUCTION 

This  book  should  appeal  to  a  very  wide  pubhc  because  it  is 
a  vivid  transcript  of  poignant  human  experience — a  record  of 
human  misfortunes  and  their  healing.  But  this  record  should 
be  especially  illuminating  because  it  is  written  by  a  man  who 
was  many  men  at  once.  He  gathered  these  human  documents 
as  a  student  of  mental  disease  and  mental  suffering;  but  he 
saw  them  also  with  the  sympathies  of  a  social  worker  and  the 
insight  of  a  philosopher.  Philosophers  do  not  often  go  to 
psychiatric  hospitals.  Psychiatrists  are  rarely  of  a  philosophic 
turn  of  mind.  Neither  philosophers  nor  psychiatrists  have 
until  lately  been  concerned  with  concrete,  moral,  educational,  or 
juristic  problems,  with  which  the  authors  here  deal. 

But  Dr.  Southard  has  in  this  book  given  us  the  mirror  image 
of  his  many-sided  mind,  incurably  interested  in  all  human  suf- 
fering, no  matter  where  it  led  or  whence  it  came,  unwilling  to 
confine  his  interest  within  any  boundaries, — scientific,  profes- 
sional, or  temperamental, — until  he  had  understood  a  sufferer's 
troubles  to  the  bottom.  He  has  given  us,  therefore,  a  book 
full  of  cross-lights.  He  lights  education  from  the  side  of  medi- 
cine, law,  and  economics.  He  shows  the  doctor  how  he  looks 
to  the  educator,  to  the  lawyer,  and  to  the  social  worker.  He 
brings  medical  habits  of  thought  into  jurisprudence,  economics, 
and  education. 

The  book  is  full  of  technical  terms  not  all  of  which  are 
translated.  But  their  meaning  is  soon  clear  from  the  context 
and  their  inclusion, — unexplained, — gives  one  a  stimulating 
sense  of  looking  straight  into  a  busy  workshop  and  gathering 
there  the  unexpurgated  details  of  the  situation.  A  heightened 
sense  of  reality  and  frankness  results.  Meantime,  we  get  a  sat- 
isfactory familiarity  with  the  psychiatric  jargon  with  which 
ere  long  pretty  much  all  professions  must  be  familiar.  Army 
men  will  have  to  know  it — since  so  many  malingerers  are  psy- 
chopaths and  so  many  mental  tests  (psychologic)  are  sure  to 
be  incorporated  in  the  army  routine  of  the  future. 

Judges  and  lawyers  have  for  some  years  past  been  getting 


X  INTRODUCTION 

inoculated  with  the  terms,  the  mental  habits,  and  concepts  of 
the  psychiatrist,  since  defective  delinquents,  epileptics,  and  the 
feeble-minded,  as  well  as  the  insane,  so  often  are  before  the 
courts. 

Politicians  and  lawmakers  must  be  familiar  with  the 
methods  and  concepts  employed  in  this  book.  For  our  laws 
on  sedition,  our  problems  of  free  speech,  the  purposes  and  per- 
formances of  our  prison  officials,  almshouse  superintendents, 
and  asylum  attendants  can  be  judged  only  in  the  light  of  psy- 
chiatric tests  and  psychiatric  results. 

*  *     *     * 

The  book  is  written  in  part  to  illustrate  how  doctor  and 
social  worker  can  co-operate  in  the  care  of  the  mentally 
deranged.  It  also  illustrates,  I  think,  how  fruitful  such  co- 
operation can  be,  because  the  doctor,  whose  long  suit  is  diag- 
nosis, gets  the  aid  of  one  much  stronger  than  he  on  treatment, 
— namely,  the  social  worker.  After  the  diagnosis  there  is 
often  little  that  the  doctor,  unaided,  can  do.  The  social  worker 
comes  to  the  front  just  there.  Provided  she  can  get  a  diagnosis 
and  prognosis  to  start  from,  she  mobilizes  for  the  patient's 
good  resources  altogether  out  of  the  doctor's  reach. 

This  has  been  part  of  Miss  Jarrett's  contribution  to  the  book. 
She  has  been  co-author  of  the  text  throughout.  But  her  in- 
fluence and  her  point  of  view  as  well  as  her  diagnostic  and 
therapeutic  efforts  have  been  active  in  the  daily  dealings  witli 
the  patients  here  pictured,  as  well  as  in  the  printed  pictures 
themselves. 

I  think,  myself,  that  if  the  psychiatrist  were  yet  a  little  more 
broad-minded,  he  would  call  the  clergyman  as  well  as  the 
social  worker  to  his  aid  and  would  find  his  patients  thanking 
him  for  a  new  sort  of  help  now  given  by  neither  doctor  nor 
social  worker.  But  that  is  for  the  Utopian  future  when  the 
clergy  get  their  rights  and  come  to  earn  almost  the  wages  of 

hodcarriers. 

*  *     *     * 

One  fact  certified  to  in  this  book  is  alone  and  of  itself  worth' 
reading  the  whole  for, — the  fact  that  more  than  one  man  who 
was  too  crazy  to  get  along  at  all  in  the  community  outside  an 
asylum  did  perfectly  well  in  the  army!  The  army,  apparently, 
is  sometimes  wiser  than  the  doctors  and  social  workers  in  its 
environmental  guidance  of  certain  poor  chaps,  who,  as  soon 


INTRODUCTION  XI 

as  demobilized,  must  again  be  clapped  into  an  insane  asylum. 
Surely  this  sheds  light  both  on  the  army  and  on  the  asylum. 
Even  though  such  cases  are  admittedly  rare,  even  though  many 
more  are  driven  into  asylums  by  army  life,  it  is  surely  an 
arresting  bit  of  information,  that  army  life  is  good  for  the 
wits  of  some.  Does  this  mean  that  the  army  provides  more 
discipline  or  less  than  the  non-military  life,  more  work  or  less, 
more  interest  or  less,  more  variety  or  less?  All  these  possi- 
bilities are  open.  Indeed,  I  have  seen  them  all  fulfilled.  But 
in  any  case  a  new  remedy  is  added  to  the  therapeutic  accoutre- 
ment of  the  average  psychiatrist  when  he  learns  (and  if  he 
believes)  that  army  life  did  really  suit  some  of  the  mentally 
diseased  patients  studied  by  the  authors. 

^  ^jc  ^  ^ 

Dr.  Southard  saw  his  profession  as  others  see  it.  That  is 
a  rare  and  valuable  power.  He  did  not  "claim  everything"  for 
psychiatry.  Yet  he  claimed  more,  perhaps,  than  anyone  else 
ever  did,  up  to  his  time.  For  since  he  included  "mental  hy- 
giene" in  the  domain  of  his  art  and  believed  that  labor  dis- 
putes, family  rows,  and  international  ambitions,  as  well  as 
crime,  alcoholism,  and  school-backwardness,  belong  in  the  field 
of  mental  hygiene, — it  might  at  first  sight  appear  that  he  set 
no  limits  to  his  profession  or  its  scope.  But  in  point  of  fact, 
limits,  definitions,  clear  dividing-lines  between  adjacent  fields 
of  professional  work,  were  almost  a  hobby  of  his, — as  this 
book  abundantly  proves.  He  divides  the  science  of  psychology 
from  the  art  of  psychiatry,  and  the  alienist  from  the  psychia- 
trist. He  refuses  to  confound  (as  psychiatrists  and  psycholo- 
gists often  do)  the  sphere  of  immorality  with  the  sphere  of 
disease.  Not  all  sinners  are  sick — in  his  view,  nor  all  criminals 
psychopaths. 

This  admirable  clearness  of  definition  is  one  of  the  out- 
standing merits  of  the  book.  He  ranges  everywhere  through 
the  emotions,  struggles,  diseases,  weaknesses,  delusions  of 
humanity.  We  are  beside  him  in  the  courtroom,  in  the  labora- 
tory, and  in  the  homes  of  some  very  queer  people.  But  he 
always  keeps  a  clear  head.  He  is  never  swept  into  a  panic  nor 
into  a  wide  glittering  generalization,  never  tempted  into  mer- 
gers that  obliterate  valuable  differences.  He  has  nothing  of 
the  fanatic  or  the  doctrinaire  except  their  energy,  nothing  of 
the  imperialist  except  his  sweep  of  vision. 


Xll  INTRODUCTION 

I  Wish  he  could  have  lived  to  compress  this  book  some- 
what. It  is  perhaps  too  literal  a  transcript  from  his  daily  life 
and  work.  Yet  there  is  an  advantage  in  his  very  copiousness 
and  reiteration.  It  is  like  life  and  teaches  like  experience.  Its 
faithfulness  to  fact  is  in  some  ways  more  impressive  than  it 
would  have  been  had  he  cut  and  selected  his  material  more 
rigidly.  Who  reads  this  book  will  learn, — as  the  writer  him- 
self learned, — a  body  of  balanced  and  cautious  doctrine,  docile 
under  the  "bludgeonings  of  chance."  We  can  hardly  forget 
teachings  reiterated  from  so  many  points  of  view — just  as  real 
life  reiterates  them.  In  the  end  we  are  landed  square  in  the 
middle  of  a  moving  train  of  thought,  orderly  and  progressive, 
but  by  no  means  at  the  end  of  its  run.  We  are  abreast  of  the 
same  difficulties,  equipped  with  the  same  solutions  that  Dr. 
Southard  and  Miss  Jarrett  were  daily  presenting  to  the  current 
army  of  workers, — doctors,  judges,  social  workers,  parents, — 
who  weave  themselves  in  and  out  of  these  pages. 

That  is  what  he  would  have  wished. 

Richard  C.  Cabot. 


CONTENTS 


BOOK  I— THE  THREE  MAJOR  SPHERES  OF  SOCIAL 
WORK  (Cases  i  to  7) 

Public,  Social^  Individual 

NojE — The  literal  formulas    (P,  S,  I;   P,   S;   etc.)    stand  for  Public,  Social, 

Individual. 

PAGE 

5 


Agnes  Jackson,   pathetic  nuisance    (P,   S,   I) 

Richard  Sully,  morbid  altruist  (P,  S)  8 

Jennie  Walton,  peculiar  thievery  (P,  I)  17 

Henry  Loyal,  "black  sheep" ;  devoted,  irresponsible 

father  (S,  I)  22 

Nora  Campbell,  ladylike  adventuress  (P)  29" 

Alfred  Mack,  industrial  disabilitj^  due  to  alcoholism 

(S)  35 

James  Bailey,  "shell-shock"  analogue   (I)  42 


BOOK  n— THE  FIVE  MAJOR  FORMS  OF  EVIL  IN 

THE  REGNUM  MALORUM  (Cases  8  to  38) 

Six  Complex  Cases   {One  Pentadic,  Five  Tetradic)   Analyzed 
by  Forms  of  Evil 

Note — The  literal  formulas   (M,  E,  V,  L,  P;  M,  E,  V,  L;  etc)   stand  for 
Morbi,  Errores,  Vitia,  Litigia,  Penuriae. 

8.  Rose    Talbot,    highly    intelligent    sex    delinquent 

(M,  E,  V,  L,   P)  51 

9.  Thomas  Fuller,  moron  who  set  a  fire  (M,  E,  V,  L)        65 

10.  Bertha  Greenwood,  hysterical  sex  delinquent   (M, 

E,  V,  P)  69 

11.  Lewis    Goldstein,    illiterate,    industrially    disabled 

(M,  E,  L,  P)  83 


XIV  CONTENTS 


PAGE 


12.  Elsa    Albrecht,    mother    of    illegitimate    children 

(M,  V,  L,  P)  ■  87 

13.  Agnes  O'Brien,   moron,   divorcee,   devoted  mother 

(E,  V,  L,  P)  95 

Ten  Less  Complex  Cases  ( Triadic  Combinations  of  Evil) 

14.  Margaret  Hersey,  deaf,  suspicious  (M,  E,  V)  98 

15.  Bessie  Polski,  "mystery  girl,"  hysterical  (M,  E,  L)       103 

16.  Mark   White,    grown-up    "spoiled    child,"   psycho- 

pathic   (M,    E,    P)  107 

17.  Eva     Collins,     weak-willed,     alcoholic,     syphilitic 

(M,  V,  L)  109 

■     18.     Hamilton  Green,  "ej-e  case,"  alcoholic,  spoiled  child 

(M,  V,  P)  113 

19.  John  Flynn,  industrial  traumatic  neurosis  (M,  L, 

P)  .        .  .  "5 

20.  Dora  Hadley,  intelligent  sex  delinquent  (E,  V,  L)      121 

21.  Bessie  Silverman,  ambitious  for  an  education    (E, 

V,   P)  126 

22.  Elliot    Calderwood,    so-called    "little   fiend,"   quite 

amenable   (E,   L,   P)  128 

23.  Julia  Brown,  who  lived  as  a  man  (V,  L,  P)  133 


Ten  Binary  Combinations  of  Evil 

24.  David  Stone,  who  feared  open  spaces   (M,   E)  137 

25.  Alfred  Stevens,  pilferer  (M,  V)  142 

26.  Kevork  Ardinian,  "work  or  fight"  problem  (M,  L)  146 

27.  Herman    Simonson,    psychoneurotic   clothes-presser 

(M,  P)  151 

28.  Aimee  Prevost,  suicidal  psychopath  (E,  V)  154 

29.  John  Manaos,  technical  deserter  (E,  L)  158 

30.  Emma   Marburg,   poor  housekeeper  with  scolding 

husband  (E,  P)  161 

31.  Alice  Nardini,  married  to  a  "black  sheep"   (V,  L)  167 


CONTENTS  XV 

PAGE 

32.  Catherine  O'Connor,  quarrelsome  wife  (V,  P)  172 

33.  Ignatz  Simanski,  forger  (L,  P)  177 

Five  Simple  Cases  of  Evil 

34.  Daniel  Griffin,  afraid  to  go  out  alone  (M)  178 

35.  John  Henry,  lad  kept  a  prisoner  by  his  mother  (E)  182 

36.  Clara   Perkins,    fabricator,    mother   of   illegitimate 

children  (V)  189 

37.  Nathan  Blumberg,  frugality  or  non-support   (L)  192 

38.  Margaret  Dolan,  poor,  old,  overworked  (P)  195 


BOOK   III— ELEVEN   MAJOR   GROUPS    OF   MEN- 
TAL DISEASES  (Cases  39  to  100) 

/.  Syphilopsychoses 

39.  Greeley  Harrison,  costly  delay  of  diagnosis  in  gen- 

eral paresis  203 

40.  Greta  Meyer,  widow  with  syphilis,  depressed  205 

41.  Walter    Heinmas,    familial    syphilis,    revealed    by 

routine  examination  207 

42.  David  Collins,  foreman  in  machine  shop  with  gen- 

eral paresis  211 

"43.     Carl  Spindler,  paretic  soldier  215 

44.  Thomas  Scannell,   steady  young  soldier  began  to 

sing,  dance,  and  fight  215 

45.  Archibald    Sherry,   twelve-year-old   victim  of   con- 

genital locomotor  ataxia  2 16 

46.  Harold    Gordon,    industrial    disability    caused    by 

syphilis  218 

//.     Hypophrenoses 

47.  Florence  Warner,   high-grade  moron   "football  of 

environment"  219 

48.  Bessie  Newman,  psychopathic  family  of  ten  mem- 

bers, each  an  individual  problem  223 


XVI  CONTENTS 

PAdE 

49.  Nathan  Rosenthal,  imbecile  kept  at  work  229 

50.  Bernard  Bomstein,  moron  street-car  conductor  in 

the  navy  232 

51.  Howard    Driscoll,    recidivist   with    honorable    dis- 

charge from  the  army  233 

52.  Beatrice  Cellini,  subnormal  girl  called  "vain,  idle, 

lazy,  selfish,  untruthful,  immoral"  234 

///.     Epileptoses 

53.  Luigi    Silva,    alcoholic    epileptic    once    a    reliable 

workman  236 

54.  Patrick  Donovan,  epileptic  who  killed  his  mother     238 

55.  Charles  Lovell,  drafted  but  discharged  240 

56.  Frank  Wayne,  enlisted  man  with  seizures  after  In- 

oculation 241 

57.  John  Bristol,  policeman,  enlisted,  had  night  attacks 

following  inoculation  242 

IV.     Pharmacopsychoses 

58.  John   Logan,   alcoholic,   expert   physicist;   valuable 

employee  244 

59.  Patrick  Nolan,  delirium  tremens  during  wife's  ab- 

sence ■  250 

60.  John   Sullivan,   discouraged   real-estate  agent  with 

alcoholic  hallucinosis  252 

61.  Margaret  Murray,  the  root  of   family  dissension, 

alcoholic  hallucinosis  257 

62.  Michael  Piso,  jealous,  feeble-minded  teamster  with 

family  in  need  262 

63.  Marian    Spring,    psychopathic   woman    with    drug 

habit  267 

F.     Encephalopsychoses 

64.  Thomas  Warren,  salesman  with  moments  when  he 

"lost  himself"  270 


CONTENTS  XVll 

PAGE 

65.     Helen    Fitzpatrick,    choreic   girl    with    illegitimate 

child  273 


VI.  Somatopsychoses 

66.  Ethel  Murphy,  unmarried  mother  with  mild  men- 

tal disease  276 

67.  Joseph  O'Brien,  mind  affected  after  influenza  277 

VII.  Geriopsychoses 

68.  Jeanette  Burroughs,  widow  who  saw  her  dead  son     279 

69.  Catherine  Cudahy,  enraged  by  the  vindictive  tick- 

ing of  the  clock  283 

VIII.     Schizophrenoses 

70.  Dana  Scott,  a  chore-man  in  the  country  suffering 

from  dementia  simplex  284 

71.  Ralph  Johnson,  compensated  schizophrenic,  once  a 

vagrant  29 1 

72.  Manual  Rizzo,  litigious  vagrant  and  counterfeiter     294 

73.  Paul  Ernst,  salesman  who  lost  his  position  through 

an  acute  attack  295 

74.  Nora  McCarthy,  spoiled  child  who  made  attempts 

at  suicide  299 

75.  Clara  Goldberg,  girl  committed  after  three  years' 

observation.  301 

76.  George  Stone,   soldier  with   croix  de  guerre  who 

developed  paranoid  conditions  after  discharge     306 

77.  George  Mullen,  left  a  state  hospital  and  enlisted     308 

78.  Paul   Dawson,   soldier  who   claimed   to  be  faking 

mental  disease  308 

79.  Howard  Lancaster,  corporal  with  dementia  praecox     310 

80.  James  Hill,  army  captain  with  dual  personality         310 


XVlli  CONTENTS 

IX.  Cyclothymoses 

PAGE 

8i.     Winifred    Reed,    young   woman    with    wandering 

spells  312 

82.  William  Donahue,  came  as  an  out-patient  because 

he  "lacked  initiative"  317 

83.  Marie  Dubois,  governess  who  needs  hospital  care 

occasionally  319 

84.  Joe  Marino,  mischievous  boy  on  probation  321 

85.  Robert     MacPherson,     sailor     given     to     "excited 

actions"  323 

86.  Clarence   Adams,    discharged    soldier    restless   and 

over-talkative  326 

X.  Psychoneuroses 

87.  Maurice  Eastman,  psychoneurotic  cigar-maker  with 

financial  worries  328 

88.  Sadie  Strauss,  hysterical  convulsions  in  a  young  girl     335 

89.  Joseph  Fangillo,  periodic  voluntary^  patient  337 

90.  Dennis  O'Donnell,  industrial  accident  case  339 

91.  Walter    Nelson,    naval    machinist   with    traumatic 

hysteria  341 

92.  Martin   O'Hara,   feeble-minded  soldier  discharged 

for  hysteria  342 

93.  Joseph    Levenson,    drafted    soldier    discharged    for 

physical  incapacity,  is  case  of  psychasthenia         344 

XI.  Psychopathoses 

94.  Harriet      Farmer,      psychopathic      typesetter,      at- 

tempted suicide,  trained  to  competence  347 

95.  Louis  Sand,  educated  Belgian,  wandering  and  ir- 

regular worker  352 

96.  Theresa  Beauvais,  girl  of  bad  heredity,  victim  of 

hypersexualis  353 

97.  Leon  Blumer,  borderline  psychopath,  quarrels  with 

his  wife  356 


CONTENTS  XIX 

FAGS 

98.  Francis   Corcoran,   boy  discharged  from   the  navy 

sick  and  "nervous"  359 

99.  Manuel  Giordani,  band  sergeant  who  broke  dovrn  360 
100.     Henry  Allen,  draughtsman  v^^ho  had  to  work  alone  361 

BOOK  IV— EPICRISIS 

I.     Relations  of  Social  Work  to  Sociology  and  Psychiatry  367 

II.     Method  of  Approach  375 

III.  The  Method  of  Book  I:  Spheres  of  Influence  385 

IV.  The  Method  of  Book  II :  Kingdom  of  Evils  390 

1.  Comparison  of  the  Kingdom  of  Evils  with  Other 

Schemes  of  Sociological  Analysis  402 

2.  Definitions  of  the  Five  Groups  of  Evils  408 

(i)   Morbi   (Diseases  and  Defects  of  Body  and 

Mind)  409 

(2)  Errores  (Educational  Deficiencies  and  Mis- 

information) 411 

(3)  Vitia  (Vices  and  Bad  Habits)  412 

(4)  Litigia  (Legal  Entanglements)  413 

(5)  Penuriae  (Poverty  and  Other  Forms  of  Re- 

sourcelessness)  415 

3.  Causes  of  Error  41^ 

4.  The  Problem  of  Evil  423 

5.  Applications  of  the  Five-Fold  Classification  of  Evils 

Outside  the  Field  of  Social  Work  430 

V.     The  Method  of  Book  III:     Main  Groups  of  Mental 

Diseases  436 

1.  Neurosyphilis  455 

2.  Feeble-mindedness  463 

3.  Epilepsies  469 

4.  Mental  Diseases  Caused  by  Alcohol  and  Drugs  470 

5.  Brain  Disease  472 

6.  Bodily  Disease  472 

7.  Old  Age  472 

8.  Dementia  Praecox  473 

9.  Manic-Depressive  Psychoses  477 


XX  CONTENTS 

»AGE 

10.  Psychoneuroses  483 

11.  Dubious  and  Special  Psychopathias  486 

VI.  Recent  Applications  of  Mental  Hygiene  492 

1.  Mental  Disease  in  the  Great  War  492 

2.  Mental   Hygiene  of  Industry  498 

3.  Out-Patient  Service  512 

VII.  Psychiatric  Social  Work  517 

1.  History  517 

2.  Organization  and  Functions  of  the  Social  Service 

at  the  Boston  Psychopathic  Hospital  523 

3.  Social  Case  Records  534 

4.  Technique  of  Social  Diagnosis  and  Treatment  538 

5.  Medical  Treatment  in  Social  Case  Work  549 

6.  Education  for  Psychiatric  Social  Work  552 

A  Note  upon  Legal  Entanglement  as  a  Division  of  Evil,  by 

Roscoc  Pound  565 

Appendices 

A.  Social  records  (full  text)  of  cases  46,  89,  and  94  571 

B.  Social  service  forms  671 

C.  Legislation  in  relation  to  mental  disease,  by  Frankwood 

E.  Williams,  M.D.  677 

Bibliography  683 

Index  699 


THE  KINGDOM  OF  EVILS 


^ 


BOOK  I 

THE  THREE  MAJOR  SPHERES 
OF  SOCIAL  WORK 

Public    (Governmental) 
Social  (Voluntary) 
Individual  (Personal) 

ANALYZED  IN  SEVEN  SPECIMEN  PSYCHIATRIC  CASES 


Then  Job  ansivered  and  said, 

Be  it  indeed  that  I  have  erred, 
Mine  error  remaincth  with  myself. 

Behold,  I  cry  out  of  zvrong, 

but  I  am  not  heard; 
I  cry  for  help,  but  there  is  no  justice. 

All  my  familiar  friends  abhor  me. 

And  they  whom  I  loved  are  turned  against  me. 

Have  pity  upon  me,  0  ye  my  friends; 
For  the  luind  of  God  hath  touched  me. 

Job,  Chapter  19,  Verses  i,  4,  7,  19,  21. 


WOMAN  ART  STUDENT 
IMMIGRATION  SERVICE 


In  England 

Bad  Heredity 
Quarreling 

Estrangement   from  Family 
Threats  Against  Family 
"Nervous  Breakdown" 
Irregular   Occupation 
Sex  Delinquency 


In  U.  S.     ' 

Convalescent  Care 
Unemployment    (Voluntary) 
Insufficient  Income 
Charitable  Aid 
Suicidal  Threats 
Public  Nuisance 
Deportation 


Undesirable  immigrant  and  pathetic  nuisance:  vicissitudes; 
deportation.  Effects  of  a  faulty  diagnosis  and  therefore 
prognosis  (neurasthenia  in  a  woman  not  at  all  neurasthenic). 
To  illustrate  public,  social,  individual  problems. 

Case  I.  Miss  Agnes  Jackson  was  sent  to  the  Psychopathic 
Hospital  for  observation  from  the  Immigration  Station  at 
Boston.  She  was  a  "mental"  suspect  and  rather  an  appealing 
figure.  She  herself  said  that  in  England  she  had  had  a  "nerv- 
ous breakdown."  It  seemed  doubtful  whether  she  could  main- 
tain herself  on  the  small  income  she  possessed,  an  allowance 
from  her  family  and  a  scholarship  to  cover  art  school  tuition. 
But  finally  she  was  admitted  to  the  country  in  the  joint  care 
of  the  director  of  the  school  she  was  to  attend  and  the  social 
service  of  the  hospital. 

Correspondence  with  England  shortly  proved  her  the  daugh- 
ter of  a  professional  man  who  had  committed  suicide  a  year 
before.  It  appeared  that  her  mother,  brother,  and  sister  were 
living  in  England;  but  that  she  could  not  get  on  with  them 
and  believed  that  they  were  persecuting  her.  Several  years 
earlier  she  had  had  a  spell  of  bad  temper  and  quarrelsomeness 
after  a  love  affair  that  did  not  come  off.  She  won  a  scholarship 
to  study  art  in  London,  but  had  not  fulfilled  her  contract. 
About  this  time  she  had  been  observed  in  a  London  hospital, 
where  the  (erroneous)  diagnosis  "neurasthenia"  was  made. 
The  parish  rector  wrote  that  she  was  "thought  to  be  not  right 
in  her  head  and  her  work  as  an  artist  was  considered  very 
moderate."  At  the  art  school  here,  however,  she  was  said  to 
have  some  unusual  native  ability. 

After  a  week  in  the  hospital  she  was  sent  to  the  country  to 
recuperate  (through  funds  raised  for  the  purpose)  because 
she  complained  of  feeling  weak  and  distraught  as  a  result  of 
her  detention  at  the  Immigration  Station  under  uncongenial 
conditions.  At  the  boarding  house  where  she  stayed  she  made 
unreasonable  demands  and  complaints,  was  untidy,  and  alto- 
gether made  herself  a  great  nuisance.     She  returned  to  begin 

5 


6  THE    KINGDOM    OF    EVILS 

her  studies  at  the  art  school,  boarding  at  a  working-woman's 
hotel.  But  in  a  few  weeks  she  took  to  her  bed  and  insisted 
on  having  her  meals  brought  to  her,  saying  that  she  would  not 
return  to  her  work,  as  she  couM  not  stand  the  atmosphere  of 
the  school.  It  was  found  that  she  had  been  very  rude  to  her 
associates  there. 

Yet  she  went  back  after  a  time  and  gave  no  trouble  for  nearly 
six  months.     A  piece  of  her  work  was  exhibited  at  a  well- 
known  shop.     As  the  pound-a-week  allowance  from  England 
had  stopped  a  friendly  artist  helped  her  out  with  small  sums. 
Miss  Jackson  herself  made  no  effort  to   sell  her  work  and 
showed  no  industry.     She  talked  a  great  deal  about  what  would 
be  done  for  her  by  this  friend  and  another  young  woman,  a 
fellow  student,  who  had  become  interested  in  her.     She  con- 
tinually talked  about  wanting  to  meet  men,  insisting  that  her 
friends  should  help  her  find  a  husband.     She  wrote  volumi- 
nous rambling  letters  to  them,  and  also  to  a  physician  at  the 
Immigration    Station,    telling    of    her    misfortunes    and    her 
unhappiness. 

Meanwhile,  she  had  turned  against  the  social  worker;  but 
finally  she  came  to  the  hospital,  weeping  and  distraught,  and 
was  taken  in  as  a  voluntary  patient.  After  a  brief  stay  she 
was  discharged,  but  pursued  the  same  tactics.  After  two 
months  the  more  serious  step  was  taken  of  committing  her  to 
a  state  hospital  for  longer  observation.  In  the  course  of  time 
she  was  sent  to  England  in  care  of  a  special  attendant,  to  be 
returned  to  her  family.  This  ends  the  American  story  of 
Agnes  Jackson  and  the  whole  story  so  far  as  it  has  yet 
unfolded. 

The  American  history  of  Miss  Agnes  Jackson  thus  lasted 
hardly  over  a  year.  The  nucleus  of  these  troubles  was  beyond 
a  doubt  psychopathic.  Although  a  psychopath  ought  to  engage 
one's  sympathy  and  although  Miss  Jackson  at  the  outset  pulled 
every  one's  heartstrings,  she  remains  in  the  minds  of  all  more 
a  pest  than  a  patient. 

Erom  the  immigration  office  standpoint  she  was  an  undesir- 
able citizen,  because  a  small  art  scholarship  and  the  pound-a- 
week  allowance  plainly  could  not  support  her  in  America. 

Erom  the  point  of  view  of  the  social  worker,  the  initial  ap- 
peal of  a  young  English  art  student  of  refinement,  dropped 
from  a  Cunarder  into  the  detention  quarters  of  the  United 


THE    KINGDOM    OF    EVILS  7 

States  Immigration  Office,  was  extreme.  Yet  whatever  was 
done  for  her  by  officials  or  by  new-found  private  friends,  all 
ended  in  a  pathetic  tangle  of  minor  troubles,  amounting  to  a 
bit  of  a  tragedy.  Whether  in  England  there  had  been  anything 
really  tragic  may  never  be  knbwn,  though  our  full  accounts 
from  London  leave  Love  largely  out  of  account  and  minimize 
the  part  that  Money  might  have  played  in  the  unfolding  of 
events.  What  tragedy  may  in  future  come  to  her  in  England 
we  cannot  say;  but  no  doubt  the  same  initial  appeals  and  the 
same  lapses  into  misunderstanding  will  continue  to  be  her  lot. 

What  after  all  is  she  from  the  medical  point  of  view?  Is 
the  fact  significant  that  an  elder  brother  is  badly  affected  with 
a  disseminated  sclerosis?  On  the  whole,  the  hereditary  taint 
in  Miss  Jackson  strikes  one  as  rather  slight.  Ample  studies 
of  her  personality  both  here  and  abroad  fail  to  place  her  case 
beyond  cavil  in  any  major  group  of  mental  diseases,  though 
no  doubt  can  attach  to  considering  her  in  some  wise  psycho- 
pathic, and  even  possibly  amongst  that  group  of  degenerative 
diseases  so  unfortunately  termed  dementia  praecox. 

As  we  study  the  case  in  detail  we  are  not  only  able  to  bring 
out  the  governmental,  social,  and  medical  troubles,  of  which 
this  "pathetic  nuisance"  was  a  paradigm,  but  we  also  find  her 
more  or  less  the  vehicle  of  many,  if  not  all,  of  the  major  sorts 
of  evil  that  the  world  (according  to  our  classification)  has  to 
face.  As  we  hope  to  show  in  the  sequel  of  this  book,  there  are 
evils  and  evils.  But  amongst  these,  we  may  distinguish  at  least 
five  great  classes.  There  is,  for  example,  the  class  of  Diseases 
into  which  Miss  Jackson  readily  falls  by  virtue  of  her  psychop- 
athy. Again,  there  are  the  evils  of  Ignorance ;  that  is,  of  poor 
education,  of  misinformation,  of  the  improper  digestion  of 
facts  through  lack  of  judgment,  not  necessarily  in  itself  psycho- 
pathic, and  of  these,  our  paradigm  case  is  not  without  good 
examples,  of  which  her  coming  to  America  at  all  may  serve 
as  the  greatest.  There  are  also  evils  of  which  the  sequel  will 
supply  far  more  striking  examples  in  which  various  Bad  Habits 
and  Vices,  non-psychopathic,  form  the  chief  constituents.  Con- 
cerning these  in  the  case  of  Miss  Jackson,  it  may  be  difficult 
to  disengage  her  laziness  and  tactlessness  from  the  effects  of 
psychopathy;  but  at  first  sight  at  least  these  ways  of  hers  struck 
her  friends  and  acquaintances  as  the  effects  not  of  disease,  but 
of  poor  training.     Sometimes  again,  the  individual  victims  of 


8  THE    KINGDOM    OF    EVILS 

trouble  fall  into  the  clutches  of  the  Law  or  of  public  service  in 
sundry  ways.  Miss  Jackson  was  a  good  enough  example  of  an 
"undesirable  immigrant."  Again  there  are  evils  of  a  purely 
economic  nature,  Poverty  and  other  forms  of  resourcelessness 
— and  it  may  be  well  supposed  that  under  certain  circumstances, 
if  the  Jackson  family  in  England  had  been  on  a  higher  eco- 
nomic level,  the  life  of  Miss  Agnes  would  not  have  been  cast 
in  its  peculiar  way,  and  in  particular  she  might  never  have 
undertaken  her  American  journey. 

Hours  spent  by  Medical  record,  65  pages 

Social  record,  26  pages 
Physician,  145^^  Social  work  : 

Visits.  13 
Psychologist,    i  Interviews  at  hospital,  14 

Telephone  calls,  20 
Social  worker,  36  Letters,  20 


Morbid  altruist  and  boys'  club  organiser.  Delinquency  ex- 
plained as  due  to  mental  disease  (psychopathic  personality).  Re- 
covery, in  all  public  and  social  senses. 

Case  2.  Richard  Sully  was  a  kind  of  morbid  altruist.  Like 
Agnes  Jackson,  Richard  was  beyond  a  doubt  psychopathic, 
yet  the  psychopathic  difficulty — a  mild  defect  of  the  group  of 
so-called  constitutional  inferiority — was  not  of  such  a  sort  as 
to  perturb  Richard's  peace  of  mind  or  any  other  of  his  internal 
relations  and  self -adjustments.  The  trouble  seemed  almost 
wholly  one  of  a  social  nature  with  occasional  public  contacts, 

Richard  first  came  under  expert  observation  at  fourteen. 
He  became  beset  with  the  idea  of  starting  boys'  clubs.  It  dis- 
tressed him,  he  said,  to  see  boys  idle  on  the  street — they  ought 
to  get  into  clubs  where  they  could  read.  He  would  hire  a 
room,  or  perhaps  a  building,  and  give  orders  for  suitable  furni- 
ture. Sometimes  he  bought  refreshments,  hid  them  in  his  own 
house,  and  ended  by  eating  them  himself,  as  the  proposed  boys' 
clubs  had  as  yet  no  members !  Between  these  organizing  efiforts 
he  worked  hard,  helping  about  the  house  and  helping  in  neigh- 
bors' houses.    He  so  helped  his  church  janitor  that  he  was  even 


THE    KINGDOM    OF   EVILS  9 

finally  made  janitor  of  the  church  at  $3  a  week.    His  earnings 
he  gave  to  his  mother. 

His  school  work  had  been  lapsing  for  about  two  years.  A 
psychological  examination  at  the  age  of  fourteen  showed  him 
to  be  by  the  Binet  Scale  actually  of  a  higher  mental  age  level 
than  his  actual  age ;  namely,  fifteen.  A  test  a  year  later  showed 
a  Binet  rating  of  12  2/5,  but  by  the  Point  Scale  he  still  rated 
at  fifteen;  in  fact  at  the  highest  level  which  the  Point  Scale 
of  Yerkes  was  at  that  time  able  to  register.  The  psychological 
examiner  reported  that  Richard  was  not  feeble-minded  and 
yielded  no  evidence  of  deterioration,  that  he  was  quick  and 
accurate  in  learning.  His  analytic  ability  was  especially  good. 
So  far  as  tests  went,  he  was  perhaps  slightly  limited  in  his 
power  to  interpret  complexities  (so-called  "apperception" 
tests).  As  for  the  other  mental  faculties  tested,  they  were  of 
satisfactory  quality,  nor  would  one  perhaps  often  find  in  a 
youthful  psychopathic  suspect  like  Richard  so  regular  a  test. 
In  particular,  he  had  grasped  and  retained  his  school  knowledge 
well.  On  the  basis  that  his  imaginative  and  planning  powers 
were  not  quite  as  strong  and  rapid  as  normal,  the  examiner 
risked  the  suggestion  that  Richard  might  possibly  be  a  patient 
defective  on  the  side  of  the  will  (and  hence  not  defective  within 
the  range  of  many  of  the  tests)  and  normal  as  to  emotions  and 
intelligence. 

We  here  specify,  concerning  these  psychometric  tests,  a  little 
more  detail  than  is  strictly  necessary;  for  we  want  to  stress 
the  great  negative  value  of  the  mental  tests.  The  patient's  com- 
paratively high  intelligence  is  a  factor  to  reckon  with  in  ex- 
plaining the  peculiarity  of  his  delinquencies,  and  a  factor  to 
be  considered  in  building  up  a  treatment  procedure  and  a 
prognosis. 

Now  the  outcome,  at  least  in  the  six  years  during  which 
Richard  has  been  under  observation,  seems  a  comparatively 
good  one.  During  the  past  four  years  there  have  been  slight 
ruffiings  of  the  surface  (occasional  inquiries  as  to  whether  it 
was  not  now  time  to  organize  another  boys'  club),  but  these 
suggestions  have  been  readily  nipped  in  the  bud  by  his 
advisers.  Once  even  he  went  so  far  as  to  utter  a  small 
check,  so  that  there  is  no  doubt  that  the  defect  of  will  is 
still  latent. 

Along  with  Richard's  rather  minor  individual   difficulties, 


10  THE    KINGDOM    OF   EVILS 

chiefly  a  defect  of  will,  it  is  plain  that  the  bulk  of  his  diffi- 
culties are  in  his  relations  with  his  family,  with  the  church 
people,  with  the  boys  whom  he  tried  to  steer  into  his  vaguely 
altruistic  clubs,  and  with  the  tradesmen  and  others  from  whom 
he  tried  to  obtain  money.  The  public — that  is,  governmental — 
aspect  of  Richard's  case  was,  with  respect  to  the  courts,  rather 
more  a  matter  of  the  "eternal  not  quite"  (when  brought  to 
court  the  judge  would  tend  to  file  the  case,  or  not  consider  it, 
on  the  score  of  Richard's  youth  and  the  peculiarity  of  his  of- 
fense) ;  yet  Richard  was  a  pretty  well-known  figure  to  the  local 
police,  who  would  from  time  to  time  step  in  as  good  neighbors 
and  help  his  mother  straighten  out  his  tangles.  Another  public, 
or  governmental,  feature  of  Richard's  case  was  his  commit- 
ment to  a  state  hospital,  which  seemed  advisable  upon  his  at- 
tempt to  float  his  fifth  club  enterprise.  That  he  had  a  definite 
psychosis  was  perhaps  never  actually  proved. 

Richard  entered  the  Psychopathic  Hospital  under  the  volun- 
tary relation  in  a  rather  peculiar  way  in  his  fourteenth  year. 
He  arose  from  bed  at  home  one  night  very  late,  took  sixty 
cents  from  his  mother's  purse,  climbed  out  of  the  window, 
hatless  and  coatless  in  a  pouring  rain,  and  reached  the  hospital 
drenched. 

There  was  a  kind  of  suggestion  of  the  epileptic  fugue  in  this 
and  similar  escapades,  yet  no  convincing  epileptic  features  were 
otherwise  discernible.  According  to  Richard,  he  read  too 
much  and  got  to  day-dreaming.  The  physicians  who  com- 
mitted Richard  to  the  state  hospital  (under  Massachusetts  law 
physicians  not  connected  with  the  state  hospital  staff  must  in 
the  interest  of  the  patient  be  called  in)  perhaps  suspected  that 
he  was  an  early  case  of  schizophrenia,  (dementia  praecox),  as 
they  called  attention  to  a  change  in  Richard's  nature  at  the  age 
of  twelve,  wherein  he  became  less  thoughtful  and  began  to  have 
things  bother  him.  He  told  the  committing  officers  that  he  did 
not  sleep  for  six  months  at  a  time.  He  told  them  that  he  had 
formed  about  fifty  boys'  clubs  of  the  same  general  nature.  He 
was  accordingly  sent  to  a  state  hospital,  and  thence  went  home 
on  a  visit  after  a  period  of  six  months,  for  the  greater  part  of 
which  he  was  granted  parole  and  helped  about  the  laundry,  a 
good  and  willing  worker.  He  was  there  regarded  as  a  "con- 
stitutional inferior."  He  was  carried  on  the  books  of  the  hos- 
pital for  six  months  and  then  discharged,  with  a  request  to 


THE    KINGDOM    OF    EVILS  II 

report  from  time  to  time  at  the  Psychopathic  Hospital.    There 
he  took  baths,  as  prescribed,  somewhat  regularly. 

With  the  exception  of  the  two  small  upsets  mentioned  above, 
he  now  became  and  still  remains  an  industrious  and  faithful 
shoe  worker  in  a  factory.  The  clubable  side  of  Richard's 
nature  has  now  got  its  satisfaction  in  sundry  church  societies. 
Richard  has  always  been  on  good  terms  with  the  Psychopathic 
Hospital  and  continually  brings  magazines  for  the  patients, 
and  at  one  time  brought  over  his  church  club  to  entertain  them. 

We  are  not  here  attempting  to  expound  the  entire  medical 
story  of  Richard  Sully;  yet  it  is  clear  that  the  diagnosis  "con- 
stitutional inferior,"  accurate  though  it  may  be,  might  well 
give  the  wrong  impression  to  laity  and  to  physicians  of  the 
prognosis.  At  the  age  of  tw^elve  a  boy  undergoes  a  change 
of  character  and  develops  a  sort  of  morbid  altruism,  endeavor- 
ing to  organize  boys'  clubs  and  breaking  rather  obvious  busi- 
ness rules  in  the  process.  He  gets  into  medical  and  social 
hands,  both  under  the  voluntary  relation  and  under  the  legal 
cjmmitment  relation  in  the  state  hospital  system,  and  somehow 
works  out  of  his  psychopathic  phase  into  a  comparatively  nor- 
mal status.  To  be  sure,  in  this  normal  status  traces  of  his  altru- 
istic trend  persist;  he  joins  church  clubs,  sings  in  the  church 
choir,  is  a  member  of  the  Massachusetts  State  Guard,  of  the 
Young  Men's  Christian  Association  and  the  like.  Yet  at  pres- 
ent he  cannot  be  regarded  as  much,  if  at  all,  outside  the  range 
of  the  normal. 

Were  there  any  features  in  Richard's  earlier  life  which 
might  have  given  a  warning?  It  is  said  that  he  had  been  some- 
what seclusive  from  early  childhood,  not  caring  to  play  with 
other  children  and  preferring  to  read  and  study  alone.  He 
cared  for  no  games  or  sports  except  skating.  He  rather  early 
attempted  to  assume  responsibility  in  his  family  and  always 
wanted  to  escort  his  mother  to  the  street  cars  and  the  like.  He 
was  for  a  long  time  troubled  with  tonsillitis,  for  which  he  was 
operated  upon.  Antitoxin  administered  for  diphtheria  at  eight 
years  of  age  partially  paralyzed  him  for  a  time.  The  sex  side 
was  regarded  as  normal. 

The  boy's  father  deserted  his  mother,  and  during  the  father's 
numerous  unexplained  absences  (before  the  final  desertion  and 
imprisonment)  Richard  grieved  greatly  and  sat  by  the  window 
to  watch  for  his  father.    After  the  final  desertion,  the  boy  con- 


12  THE    KINGDOM    OF   EVILS 

ceived  and  stated  that  he  now  had  a  family  to  support,  though 
he  was  then  but  eight  years  of  age.  It  is  possible,  or  at  least 
conceivable,  that  a  precocious  ripening  process  in  the  boy's 
mind  was  somehow  started  after  his  father's  desertion  of  the 
family.  Both  the  father  and  the  paternal  grandfather  were  sex 
delinquents,  and  the  paternal  grandfather  was  a  suicide.  The 
paternal  grandmother  and  two  siblings  were  respectively  un- 
social, suicidal,  and  sex  delinquent.  A  younger  sister  of  the 
patient  is  choreic.  Upon  the  maternal  side  there  seems  to  be 
no  taint,  unless  a  certain  tendency  to  vascular  disease.  So  far 
in  Richard's  history  the  other  sex  has  not  appeared,  save  in 
his  normal  relations  with  his  sisters.  His  interests  have  con- 
stantly attached  themselves  to  persons  of  his  own  sex.  A  psy- 
choanalyst who  examined  him  was  inclined  to  regard  him  as 
showing  a  "conflict,  somewhat  homosexual."  This  diagnostic 
suggestion  was  thought  to  be  supported  by  the  so-called  "intel- 
ligence complex"  shown  in  association  tests,  wherein  twenty- 
eight  per  cent  proved  to  be  "logical  definitions."  The  thought 
that  after  his  father's  desertion  he  must  now  be  the  head  of 
the  family  was  also  regarded  by  the  psychoanalyst  as  supporting 
the  above  mentioned  "conflict."  It  seems  that  at  the  age  of  six 
Richard  had  been  excluded  from  some  club  of  boys  of  his  own 
age,  whereupon  he  had  begun  to  dream  of  a  club  of  his  own, 
which  dreams  may  possibly  have  started  the  club  forming  habit 
of  his  early  teens. 

The  social  worker  at  the  state  hospital  where  Richard  spent 
six  months  several  years  ago  still  supervises  him.  She  wrote 
us  the  following  report  recently : — 

"Since  I  reported  to  you  in  March  1919,  Richard  has  been 
getting  on  exceedingly  well.  He  has  been  working  regularly 
at  Gordon's  Shoe  factory  in  East  Boston  and  is  now  on  piece 
work  and  earns  an  average  of  four  or  five  dollars  a  day,  and 
sometimes  makes  as  much  as  seven  dollars  a  day.  He  has  not 
attempted  to  take  any  responsibility  in  the  Church,  although  he 
has  attended  their  young  people's  meetings  faithfully  and  still 
enjoys  his  associations  there. 

"During  the  summer  he  had  a  vegetable  garden  in  one  of  the 
lots  given  out  by  the  City,  in  which  he  worked  after  returning 
from  the  factory  at  night  and  during  other  spare  hours.  This 
proved  to  be  very  beneficial,  as  it  kept  him  outdoors  and  gave 
him  healthful  exercise,  as  well  as  helping  the  family  with  the 
food  problem.    His  mother  helped  him  in  this. 


THE    KINGDOM    OF    EVILS  13 

"Although  he  had  secured  his  discharge  from  the  Local  State 
Guard  Company,  in  which  he  had  been  a  Corporal, — upon  our 
suggestion, — when  the  Police  Strike  occurred  in  September  the 
men  asked  him  to  re-enlist  and  he  felt  it  his  duty  to  do  so.  He 
served  with  them  during  this  trouble,  but  when  the  worst  was 
over,  he  resigned  again  upon  our  urging  him  to  do  so,  as  it 
was  keeping  him  from  getting  as  much  sleep  as  he  needs. 
Because  of  his  mental  condition  we  did  not  approve  of  his  doing 
a  thing  of  that  sort,  although  we  did  not  know  he  was  out  on 
duty  until  he  had  been  there  a  few  weeks.  As  it  was,  nothing 
happened  and  he  quite  enjoyed  the  experience,  and  the  factory 
made  up  his  weekly  pay  to  the  average  of  what  he  was  making 
at  the  plant. 

"The  local  Red  Cross  Home  Service  has  been  visiting  the 
family  during  the  past  year  as  Mrs.  Sully  discovered  that  her 
husband  was  in  the  Canadian  Army  and  they  helped  her 
to  get  money  from  Canada.  They  have  kept  strictly  off  the 
problem  of  Richard  individually,  but  I  am  glad  to  have  them  in 
closer  touch  with  the  family  than  I  could  be." 

We  have  to  deal,  then,  with  a  boy  who  apparently  passes 
through  a  minor  psychopathic  phase  for  a  period  of  three  or 
four  years  about  the  time  of  adolescence,  but  before  and  after 
this  phase  shows  but  few  signs  of  such  a  trend.  Various 
diagnoses  from  the  medical  side,  such  as  constitutional  inferior, 
predementia  praecox,  early  dementia  praecox,  even  epilepsy  and 
manic-depressive  psychosis,  were  from  time  to  time  offered. 
The  committing  officers,  bound  to  act  on  concrete  data,  were 
nevertheless  in  not  the  slightest  doubt  as  to  their  duty  to  com- 
mit him  to  a  state  hospital.  Before  this  latter  decision  w^as 
arrived  at,  all  sorts  of  doubts  had  reigned  concerning  the  diag- 
nosis, some  physicians  proposing  that  he  was  not  demonstrably 
psychopathic,  but  was,  on  the  contrary,  a  rather  pure  example 
of  a  delinquent,  deserving  prison  bars  rather  than  the  comforts 
of  an  asylum. 

We  analyzed  the  case  of  Agnes  Jackson  not  only  from  the 
standpoint  of  the  description  of  her  troubles  as  public,  social, 
and  individual,  but  also  (anticipating  the  considerations  of 
Book  H)  from  the  standpoint  of  the  kinds  of  social  evil,  of 
maladjustment,  which  she  displayed.  Following  a  similar  plan 
with  Richard  Sully,  we  find  him  falling,  of  course,  in  the  class 
of  Morhi  (Diseases)  by  virtue  of  his  mild  psychopathy. 
Whatever  be  the  trend,  or  eventual  outcome,  of  this  psychop- 


14  THE    KINGDOM    OF    EVILS 

athy,  (schizophrenic,  epileptic,  or  otherwise),  Richard  Sully 
has  at  all  events  what  physicians  call  a  forme  fruste  of  some 
sort  of  mental  disease  or  defect. 

How  shall  we  classify  Richard  with  respect  to  Err  ores,  the 
evils  of  Ignorance?  Unlike  Agnes  Jackson,  who  did  show  the 
effects  to  some  extent  of  poor  education,  misinformation,  and 
lack  of  judgment,  Richard  not  only  tested  well  by  the  set  psy- 
chological tests,  but  seems,  on  the  whole,  to  have  been  rather 
well  educated  and  well  informed.  An  adult  insight  and  judg- 
ment should  not  be  expected. 

On  the  side  of  the  Vitia,  that  is,  the  Bad  Habits  and  Vices, 
Richard  must  be  regarded  as  equally  without  pronounced  de- 
fect, unless  we  regard  with  some  authors  any  sort  of  exagger- 
ated altruism  as  a  form  of  vice !  Shall  we  regard  the  forgeries 
and  other  delinquencies  as  at  all  the  effects  of  moral  perversion? 
Certainly,  the  tendency  of  the  Psychopathic  Hospital  staff  in  its 
analysis  of  Richard  was  to  regard  these  defects  as  rather  more 
psychopathic  (that  is.  'falling  within  the  group  of  mental  dis- 
eases), than  morally  vicious.  (We  do  not  care  to  take  up  here 
the  question  of  an  eventual  proof  that  some  one  may  bring 
that  moral  perversion  is  in  and  of  itself  psychopathic.  Such 
a  proof  may  possibly  arrive.  For  the  present,  however,  we  are 
employing  the  group  of  the  Vitia  to  contain  such  bad  habits 
and  vices  as  might  conceivably  be  drilled  out  of  the  bearer  by 
proper  moral  training,  or  even  prevented  by  proper  early  man- 
agement. It  is  in  this  latter  sense  of  the  group  of  the  Vitia 
that  we  do  not  regard  Richard  Sully  as  a  morally  dishonest  or 
immoral  person.) 

Clearly  Richard's  case  falls  in  the  group  of  the  Litigia,  that 
is,  of  legal  and  similar  entanglements ;  for  as  we  have  seen,  he 
was  frequently  at  least  within  the  shadow  of  the  courts. 

It  is  true  that  the  economic  status  of  the  family  was  at  best 
"marginal,"  but  no  special  effect  upon  the  psychopathic  status 
of  the  boy  can  be  ascribed  to  the  plight  of  domestic  economy. 

Hours  spent  by  Medical  record,  47  pages 

Social  record,  10  pages 
Physician,  7  Social  work: 

Visits,  4 
Psychologist,   i  Interviews  at  hospital,  4 

Telephone  calls,  8 
Social  worker,  12  Letters,  13 


PSYCHOPATHIC  THIEF 
WOMAN    (ILLEG.)    27 

1Q16  19 1 y 

Arrest  Discharged  from  Probation 

Poor   Health  Care  of  Body  (incl.  Teeth) 

Cut  Off  from  Family  Living  with  Friends 

COMPLICATION  :   CHILDHOOD   SEX  TRAUMA 


Thief.  Infantile  sex  experience.  Physical  and  psychical 
waves  of  disease.  "Empathic  index"  question.  "The  patient's 
confidence."     Public  and  individual  problems. 

Case  3.  Jennie  Walton's  mother  is  said  to  have  had  some 
Indian  blood.  Jennie  was  an  illegitimate  child,  and  her  pater- 
nity was  never  established.  We  present  her  as  a  paradigm  of 
mental  disorder  leading  to  public  (governmental)  rather  than 
family  or  other  social  complications.  Medically,  she  should 
probably  be  placed  amongst  the  psychopathies.  She  was 
arrested  for  stealing,  and,  although  one  might  be  tempted  to 
make  a  diagnosis  of  kleptomania,  on  the  whole  the  delinquency 
is  probably  a  minor  incident  rather  than  the  effect  of  a  strongly 
marked  special  instinct,  and  the  fact  that  simple  and  obvious 
social  service  measures  served  to  straighten  out  the  Walton 
case  (without  resort  to  elaborate  and  specially  designed  reedu- 
cation or  moral  reformation)  permits  us  to  think  that  her  psy- 
chopathy was  of  a  minor  degree.  Such  merely  social  (non-gov- 
ernmental) complications  as  did  exist  were  so  slight  as  to  be 
negligible. 

Jennie  Walton  came  under  hospital  observation  at  the  age  of 
twenty-seven,  having  been  arrested  for  stealing  patients' 
clothes,  linen,  a  fur  coat,  and  utensils  from  two  hospitals, 
where  she  had  been  employed  as  a  domestic  for  half  a  year 
previous.  The  girl  had  been  of  such  exemplary  character  and 
had  so  many  intelligent,  good  friends  amongst  previous  em- 
ployers that  the  arrest  came  as  a  shock  to  these  friends,  one  of 
whom  wrote  that  the  arrest  must  be  a  "fearful  mistake"  due  to 
a  "conjunction  of  circumstances  seeming  to  implicate  her." 

However,  it  appeared  that  her  work  at  the  hospitals  from 
which  she  stole  had  not  really  been  satisfactory  and  that  for 
a  period  of  some  five  years  those  who  knew  her  well  thought 
her  disposition  peculiar  in  that  she  was  "almost  morbidly  sensi- 
tive, heedless,  impulsive,  and  reckless  with  money."  As  for  a 
previous  history  of  stealing,  there  was  none;  but  she  was  noted 
for  collecting  and  hoarding  buttons,  ribbons,  clippings,  and 

17 


l8  THE    KINGDOM    OF    EVILS 

poems.  She  seemed  to  be  rather  ambitious  and  of  the  type 
known  as  a  "born  leader."  She  had  a  certain  skill  in  making 
clothes  out  of  cast-off  things,  but  no  motive  of  self -adornment 
could  be  traced  in  several  of  her  pilferings.  In  thirteen  years 
of  work  in  various  families  she  had  saved  no  money  what- 
ever. One  might  naturally  inquire  whether  such  a  patient  as 
Jennie  was  more  or  less  hypophrenic  (feeble-minded).  Mental 
tests  led  the  psychologist  to  say  that  the  patient  was  certainly 
not  feeble-minded.  She  yielded  a  fairly  even  rating  at  the  four- 
teen year  level,  losing  some  points  on  her  association  tests  and 
on  the  tests  for  logical  and  practical  judgment ;  that  is,  the  see- 
ing of  analogies  and  absurdities  and  the  like.  Should  she  be 
regarded  as,  if  not  a  moron,  then  perhaps  a  border-line  or  sub- 
normal person,  in  the  sense  of  being  above  the  moron  level  but 
below  the  normal?  The  psychologist  remained  in  doubt,  but 
went  so  far  as  to  say  that  the  patient  graded  somewhat  below 
expectation  for  her  age  and  class.  Now  her  "class"  looked 
better  to  the  psychologist  and  to  any  casual  observer  than  it 
proved  to  be.  She  had  a  shell  of  special  information,  having 
taken  special  courses  in  domestic  science  and  in  first  aid  for  the 
injured,  but  in  the  meantime  had  never  completed  her  grammar 
grades. 

When  the  girl  was  a  baby,  her  mother  was  married  to  a  man, 
not  the  girl's  father,  an  alcoholic  and  abusive  person  who 
allowed  the  mother  to  support  the  family.  Sex  relations  (age 
seven  to  fourteen)  with  this  alcoholic  stepfather  formed  a 
rather  extraordinary  episode  in  the  girl's  history,  according  to 
her  own  story.  In  the  girl's  conscious  life  this  history  played 
a  considerable  part.  She  complained  bitterly  of  the  robbery 
"of  all  that  is  dear  to  a  woman."  She  would  readily  tell  neither 
about  the  larceny  nor  about  the  sex  history,  nor  was  any  one 
of  several  medical  approaches  successful  in  starting  a  stream 
of  confidences.  Finally  a  friend  and  confidante  was  found  to 
whom  enough  of  both  stories  was  confessed  that  the  main  out- 
lines of  the  situation  were  clear. 

The  medical  side  of  the  story  was  not  without  bearing  on 
the  patient's  estimate  of  herself  and  upon  the  psychiatric  diag- 
nosis. She  had  had  many  and  various  children's  diseases.  At 
eighteen  she  described  herself  as  having  had  a  kind  of  general 
debility  from  overwork.  Whether  this  was  connected  with  her 
engagement  to  a  man  at  nineteen,  broken  off  when  the  man 


THE    KINGDOM    OF    EVILS  1 9 

shortly  afterwards  entered  a  forced  marriage  with  another 
woman,  remains  doubtful ;  but  the  old  incest  story  and  the 
breaking  of  this  engagement  "soured  her,"  she  said,  "on  all 
mankind,"  so  that  she  was  in  a  way  "to  become  a  man-hater." 
In  this  nineteenth  year  it  appears  that  she  had  a  sort  of  exhaus- 
tion attack  for  a  fortnight.  She  was  operated  on  at  the  age  of 
twenty-four  for  appendicitis,  and  in  her  twenty-fifth  year  re- 
sorted to  an  osteopath  for  exhausted  muscles.  In  her  twenty- 
fifth  year  she  was  operated  on  for  peritoneal  adhesions;  her 
ovaries  were  removed  at  this  time.  Concerning  the  oophorec- 
tomy, she  claimed  that  it  was.  in  the  opinion  of  her  physicians, 
made  necessary  by  the  trauma  of  her  childhood.  She  had  then 
woven  her  incapacity  to  bear  children  into  the  general  situation 
of  disgust  with  the  world. 

Yet,  despite  all  this  checkered  history  and  interweaving  of 
embittered  comment  by  the  victim  and  although  for  the  first 
part  of  after-care  by  the  social  service  her  behavior  was  in 
some  respects  queer  and  even  psychopathic,  at  the  end  of  a 
year  she  had  so  far  restored  herself  to  a  normal  attitude  that 
her  case  was  closed  by  the  hospital  social  service  and  was  placed 
on  file  by  the  court. 

One's  prediction  about  the  future  of  such  a  case  as  that  of 
Jennie  Walton  might  well  be  influenced  by  preconceived  no- 
tions. If  we  took  her  for  an  inborn  psychopath  of  mild  degree 
— the  psychopathia  being,  as  it  were,  stamped  in  by  childhood 
sex  experiences  and  at  last  emerging  in  the  overt  act  of  lar- 
ceny— we  might  give  her  a  rather  unfavorable  prognosis.  At 
the  time  of  hospital  observation  she  was  in  rather  poor  health. 
Her  teeth,  especially,  were  bad.  It  transpired  also  that  she 
had  been  for  eighteen  months  at  a  state  hospital  for  tubercu- 
losis (pulmonary,  no  longer  in  evidence),  ^\'e  must  remember 
the  occasional  spells  of  exhaustion,  dating  from  the  late  teens, 
which  though  ill  described,  may  possibly  represent  some  sort  of 
periodic  or  wave  eft'ect  in  her  physique,  reflected  also  in  her 
mental  life. 

We  have  recorded  that  the  psychometric  rating  left  case 
Walton  as  certainly  not  a  moron  and  as  not  clearly  subnormal 
in  a  milder  degree.  Psychiatrically  examined  she  proved  not 
abnormal.  She  was,  to  be  sure,  somewhat  sad  at  times,  but  a 
psychopathic  depression  could  not  be  proved.  The  only  ques- 
tion raised  was  that  of  delusions,  as  lennie  told  a  storv  of  the 


20  THE    KINGDOM    OF    EVILS 

conspiracy  of  fellow  employees,  suggestions  to  inaugurate  a 
strike,  refusal  to  admit  sex  advances  by  hospital  employees, 
placement  of  articles  in  her  room  by  fellow  employees  wishing 
to  do  her  injury,  and  the  like.  These  stories  were  interpreted 
by  us  as  part  of  the  defense-reaction  of  one  charged  with 
delinquency. 

A  systematic  review  of  her  case  by  physicians  and  social 
workers  in  staff  meeting  led  to  the  diagnosis  of  "psychopathic 
personality,"  but  without  especial  grounds  therefor,  except  the 
patient's  history  and  the  general  impression  that  somehow  she 
was  psychopathic  rather  than  delinquent.  Several  physicians 
thought  the  outlook  was  medically  bad.  Some  physicians 
thought  she  might  be  merely  psychopathic  in  the  mild  sense  of 
the  so-called  psychopathic  personality,  but  that  she  might  even- 
tually turn  out  to  be  psychotic  (in  the  sense  of  having  a  definite 
mental  disease). 

After  the  first  six  months  of  her  period  of  social  supervision, 
she  seemed  to  bear  out  this  idea  of  poor  prognosis.  In  a  vari- 
ety of  domestic  places  the  girl  did  on  the  whole  rather  poorly, 
and  from  time  to  time  rather  suspicious  things  happened.  A 
pin  or  two  disappeared,  which  she  might  have  stolen ;  a  fire 
was  set,  possibly  by  her.  One  night  she  moaned  in  bed  for 
hours  and  stayed  in  bed  the  next  day.  She  sometimes  resorted 
to  osteopathy,  and  got  a  diagnosis  at  a  general  hospital  out- 
patient department  of  "chronic  arthritis  (teeth)"  whereupon 
she  went  regularly  to  a  dental  clinic.  She  came  down  with 
German  measles  and  had  a  bad  cold  and  the  grippe.  Mean- 
time she  kept  endeavoring  to  get  work  and  to  do  it  as  well  as 
possible,  and  by  the  end  of  a  year  she  seemed  to  have  worked 
out  of  her  susceptibility  to  illnesses  and  got  upon  a  better  level 
of  physique  (all  this  helped  out  by  a  pleasant  summer  with 
friendly  people).  There  were  no  further  suspected  stealings  or 
other  bits  of  odd  behavior.  Accordingly,  as  above  noted,  her 
case  was  put  upon  file. 

We  note  that  the  exceedingly  few  social  complications  in 
Jennie  Walton's  case  rendered  social  service  relatively  easy,  as 
throughout  her  adult  life  it  still  proved  possible,  after  her  mis- 
adventures, for  her  to  find  good  and  highly  appreciative  friends. 
It  took  some  six  months  for  her  psychopathic  phase  (if  it  was 
such)  to  pass  and  for  the  social  workers  to  establish  them- 
selves on  a  confidential  basis.     This  was  not  so  much  a  ques- 


THE    KINGDOM    OF    EVILS  21 

tion  of  continued  or  increasingly  clever  efforts  at  gaining  Jen- 
nie's confidence  as  it  was  a  matter  of  the  passing  of  what  we 
finally  concluded  to  be  a  pretty  definite  psychopathic  phase. 
Whereas  it  would  not  be  safe  to  think  of  Jennie  Walton  as 
clearly  a  periodical  psychopath  (in  the  sense,  e.g.,  of  the  so- 
called  cyclothymic  constitution),  nevertheless  a  review  of  her 
entire  history  yields  traces  of  such  a  phasic  course. 

Should  she  again  appear  in  the  courts  or  in  the  hospital  and 
fall  again  within  the  medical  and  social  service  range,  no  doubt 
the  procedure  would  be  much  clearer.  In  the  meantime  it  would 
be  medically  impossible  to  say  either  that  she  is  definitely  peri- 
odic or  that  she  is  at  all  certain  to  have  a  further  episode. 
Amongst  the  ill-defined  psychopathias  which  fall  short  of  the 
full-blown  psychoses  (which  latter  we  find  typically  in  insti- 
tutions), there  may  be  a  kind  of  psychopath  with  a  periodical 
trend,  a  sort  of  forme  fruste  of  the  out-and-out  "manic-depres- 
sive" psychosis.  Yet  various  other  psychoses  have  periodical 
or  phasic  tendencies.  After  all,  the  psychologist  did  find  a 
certain  subnormality  about- the  case,  a  certain  lack  of  logical 
and  practical  judgment.  Sundry  misspellings  and  a  certain 
simplicity  characterize  her  letters.  Thus  (after  receiving  a 
Christmas  present)  : 

"I  simply  cannot  find  a  thank  you  big  enough  to  tell  you 
how  delighted  I  was  with  the  dear  little  book  you  sent  me. 
When  I  read  it  my  delight  was  doubled  threefold,  for  I  think 
the  good  fairy  whispered  to  you  that  it  was  a  set  of  my  favorite 
quotations  which  I  have  scattered  around  on  scraps  of  paper 
and  which  never  can  be  found  when  needed  most  to  drive  a 
cloud  of  the  blues  away." 

Again  we  may  try  to  resolve  this  case  from  the  standpoint 
of  the  distribution  of  social  evils.  We  have  sufficiently  dis- 
cussed her  disease  and  its  rather  doubtful  end,  yet  there  are 
plain  somatic  as  well  as  psychic  factors  therein.  As  for  poor 
education,  there  is  a  certain  evidence  of  this,  and  a  certain 
superficiality  in  the  education  which  she  had  actually  received ; 
.but  it  does  not  appear  that  her  comparatively  poor  education 
really  contributed  much  to  her  difficulty,  nor  is  it  easy  to  ascribe 
to  her  any  altogether  unfortunate  moral  attitude,  despite  the 
fact  that  her  interpretation  of  her  childhood  misfortunes  and 
of  her  later  psychopathic  complications  were  not  always  sound. 
Yet  it  is  probable  that  the  unsoundness  of  these  interpretations 


22  THE    KINGDOM    OF    EVILS 

is  to  be  attributed  rather  to  her  psychopathy  than  to  any  actually 
poor  moral  training.  Her  legal  difficulties  are  obvious  and 
no  doubt  tended  to  obscure  the  physician's  interpretation  of 
her  case  on  account  of  the  defense-reactions  so  natural  to  men 
and  women  when  entangled  in  court.  Nor  was  the  Walton  case 
particularly  a  case  of  economic  disability,  though  her  state  was 
"marginal"  rather  than  on  the  so-called  "comfortable"  level. 
Nor  was  the  will  to  earn  her  living  ever  lost.  The  difficulties 
facing  the  social  workers  in  their  general  attitude  to  such  a 
case  are  not  easy  to  state.  In  the  face  of  a  rather  poor  medi- 
cal prognosis  (to  say  nothing  of  the  prevailing  general,  though 
baseless,  feeling  of  doubt  as  to  the  outcome  in  all  psychopathic 
cases),  the  social  workers  had  the  duty  of  keeping  up  their 
supervision  steadfastly  until  somehow  the  patient's  mental 
state  cleared  up.  This  process  of  clarification  of  Jennie  Wal- 
ton's mind,  running  pari  passu  with  a  great  improvement  in  her 
physique,  took  about  a  year  to  bring  itself  about. 

Hours  spent  by  Medical  record,  33  pages 

Social  record,   26  pages 
Physician,  6  Social  work: 

Visits,  66 
Psychologist,  i  Interviews  at  hospital,  4 

Telephone  calls,  17 
Social  worker,  112  Letters,  40 


Black  sheep.  Generalized  psychopathia  sexualis.  Neuras- 
thenia elements  removed.  Moral  improvement  ("more  of  a 
man"  suggestions) .     Social  and  individual  problems. 

Case  4.  Henry  Loyal  was  a  steamfitter.  He  had  been  for 
many  years,  at  least  since  puberty,  in  constant  social  difficulties. 
Looking  back  over  his  life  up  to  the  age  of  forty-eight,  one 
was  tempted  to  relate  these  difficulties  to  drunkenness,  gambling 
habits,  sex  escapades,  and  a  sort  of  general  irresponsibility  in 
life.  He  was  the  acknowledged  black  sheep  of  a  middle-class 
American  family.  An  analysis  of  this  so-called  black  sheep 
will  prove  conclusively  that  he  was  a  psychopath,  and  that  all 
his  troubles,  medical  and  social,  could  be,  and  have  in  fact  been, 
greatly  improved  by  the  hard  work  of  his  official  friends. 

His  friends,  whether  medical,  social,  or  casual,  could  not 


THE    KINGDOM    OF    EVILS  23 

fail  to  be  impressed  with  the  profound  irresponsibility  of  the 
steamfitter.  What  with  the  fit  fulness  of  his  trade  and  the 
numerous  occasions  in  which  his  psychopathy  would  break  out, 
the  task  of  adjusting  him  to  an  environment  was  not  easy. 
Nevertheless,  in  the  end,  what  with  advice  to  the  man,  advice  to 
his  wife,  and  an  unusually  close  supervision,  he  has  now  become 
what,  without  straining  the  point,  may  be  called  an  encourag- 
ing example  of  psychiatric  social  work. 

The  case  was  most  unpromising,  and,  throughout  our  four 
years'  supervision,  it  was  never  possible  to  avoid  an  occasional 
lapse  into  destitution  on  the  part  of  the  family,  and  recurrent 
dissipation  on  the  part  of  its  central  figure.  There  was  a  slack, 
profane  wife,  who  was  alternately  devoted  and  jealous,  and 
there  were  four  children,  all  variously  affected  by  disease  or 
defect  (one  choreic,  another  tuberculous). 

The  husband  had  long  been  so  hopeless  a  figure  that  one's 
first  impulse  would  naturally  be  to  sever  him  from  the  family, 
try  him  a  while,  and  perhaps  finally  set  him  adrift  (as  one  says, 
"close  the  case"),  and  do  one's  best  with  the  wife  and  children. 
The  family,  however,  despite  the  centrifugal  tendencies  of  the 
father  and  the  profanity  and  extraordinary  jealousy  of  the 
mother,  was  close  knit  with  profound  affection.  The  paternal 
affection  was,  in  fact,  the  main  social  lever.  The  existence  of 
this  lever  was  all  the  more  astonishing  as  the  man  had  for 
years  come  home  drunk  and  surly,  or  stayed  away  from 
home  in  irregular  sex  life,  or  loafed  about  for  days, 
weeks,  and  months,  gambling:  every  now  and  then  subject  to 
violent  spells  of  rage  and  cruelty.  When  one  learned  from 
the  history  in  his  teens  of  all  manner  of  unspeakable  sex  prac- 
tices, and  an  early  development  of  thoughtless  and  irregular 
tendencies,  one  was  the  more  convinced  that  really  nothing 
could  be  done.  When  one  looked  into  the  family  history  and 
discovered  psychopathic  taint  in  several  near  relatives,  one  could 
only  feel  the  more  certain  that,  after  all,  one's  efforts  might  well 
be  wasted. 

What  shall  we  term  Henry  Loyal  medically?  The  strong 
heredity,  though  it  strengthens  our  idea  that  there  exists  some 
unusual  blot  in  this  social  defective,  does  not  point  to  a  particu- 
lar group  of  mental  diseases  having  a  particular  prognosis. 
When  the  man  came  before  the  Psychopathic  Hospital  staff,  it 
showed  diagnostic  leanings  in  many  directions.     For  example. 


24  THE    KINGDOM    OF    EVILS 

he  was  suspicious  of  his  hospital  friends  and  rather  apprehen- 
sive. If  one  stretched  a  point,  one  might  think  of  him  as  sub- 
ject to  the  so-called  paranoid  trend,  and  therefore  almost  think 
of  dementia  praecox.  Yet  on  the  whole,  the  suspiciousness  and 
apprehensiveness  of  the  man  were  hardly  more  than  might  be 
expected.  Again,  Loyal  had  been  markedly  depressed  and  his 
depression  was  in  sundry  details  not  inconsistent  with  the  diag- 
nosis of  manic-depressive  psychosis  (in  fact,  he  had  feared 
that  he  was  going  to  commit  suicide  about  three  weeks  before 
he  was  observed  in  hospital).  On  the  whole,  however,  there 
was  no  good  reason  for  regarding  the  depression  as  psychic, 
and  suicide  might,  with  a  certain  type  of  mind,  be  regarded 
almost  as  a  natural  thought  in  the  family  abyss.  Again,  Loyal 
might  be  regarded  as  inclined  toward  the  group  of  the  psycho- 
neuroses  on  account  of  his  hypochondria  and  headaches.  Head- 
aches had  been,  in  fact,  for  him  the  main  medical  feature  in 
his  life.  Once,  too,  he  had  fallen  and  had  an  attack  which, 
owing  to  his  being  drunk  at  the  time,  was  called  delirium  tre- 
mens. Whether  this  attack  was  actually  alcoholic,  whether  it 
was  not  in  part  hysterical,  or  whether  it  may  have  been  at  bot- 
tom epileptoid,  was  another  group  of  questions.  Amongst  the 
ten  or  eleven  great  groups  of  mental  disease  recognized  by 
most  modern  psychiatrists,  one  might  therefore  think  of  ade- 
quate reasons  for  putting  him  in  more  than  half.^ 

When  a  case  with  numerous  psychopathic  features  does  not 
strike  one  as  definitely  epileptic,  psychoneurotic,  schizophrenic 
(dementia  praecox),  or  cyclothymic  (manic-depressive),  one 
is  likely  to  let  it  fall  into  a  group  for  which  the  favorite  psychic 
designation  of  the  present  day  is  "psychopathic  personality." 
Though  the  psychiatrist  might  be  put  to  it  to  define  this  term, 
it  is  enough  to  say  here  that  the  so-called  psychopathic  person- 
alities are  rather  apt  to  bear  traits  that  look  in  one  or  other 
of  the  directions  just  mentioned,  and  on  the  whole  to  strike 
even  the  lay  observer  as  in  some  degree  childish.  This  latter 
idea  of  the  childishness  of  these  patients  is  expressed  by  some 
authors  by  the  phrase  "infantilism,"  as  if  the  "below  par"  level 
(Minderzvcrtigkeit  of  the  Germans)  was  somehow  an  expres- 
sion of  a  slight  lack  of  development.  Some  classifiers  use  the 
phrase  "constitutional  psychopathic  inferiority"  for  these  cases, 

'  See  pages  436-491  for  general  discussion  and  charts  dealing  with  the  main 
groups  of  mental  diseases. 


THE    KINGDOM    OF    EVILS  25 

and  this  phrase  is  even  to  be  found  in  our  American  immigra- 
tion laws. 

But  when  we  choose  to  term  a  man  a  psychopathic  personahty 
or  a  psychopathic  inferior,  we  must  constantly  bear  in  mind 
the  dififerent  directions  which  the  mild  infantilism  may  take. 
There  was  always  a  doubt  in  the  Loyal  case  just  what  particular 
direction  we  could  describe  the  psychopathy  as  taking,  espe- 
cially since  there  was,  in  addition  to  the  suspiciousness,  the 
depression,  the  hypochondria  and  headaches,  and  the  possibly 
epileptoid  attacks,  also  a  tremendous  hypersexuality,  so  that 
one  might  almost  think  of  terming  the  man  a  sort  of  diffuse 
psychopathia  sexiialis.  In  most  of  these  directions  he  was 
somewhat  influenceable,  and  on  the  whole  the  psychoneurotic 
trend  is  perhaps  to  be  preferred,  if  we  must  press  Loyal  into  a 
single  compartment.  How  profoundly  important  the  choice  of 
a  diagnosis  may  be  is  to  be  seen  from  the  fact  that  by  pursuing 
the  way  of  therapy  (even  in  this  very  unpromising  case),  the 
year-long  tendency  to  worry  and  the  habit  of  headaches  (fifteen 
years)  were  actually  terminated  by  treatment. 

At  this  point  let  us  try  to  throw  Henry  Loyal  into  contrast 
with  Agnes  Jackson.  Miss  Jackson  was  for  us  a  paradigm  of 
medical,  social,  and  governmental  troubles,  a  victim  perhaps  of 
mild  schizophrenia  (dementia  praecox),  the  primary  solution 
of  whose  troubles  lay  in  the  proper  adjustment  of  medical  and 
social  work  to  the  Immigration  Office  rules  and  regulations.  If 
we  try  to  analyze  the  case  of  Henry  Loyal  from  this  standpoint, 
we  find  his  troubles  chiefly  medical  and  social.  To  be  sure, 
from  time  to  time  the  Loyal  family  would  fall  into  destitution 
and  require  public  or  semi-public  aid  mechanized  by  more  elastic 
means  than  are  ordinarily  possible  for  strictly  public  agencies. 
In  short,  Henry  Loyal  was  a  public  or  governmental  case  only 
in  an  incidental  or  occasional  way.  He  is  a  fairly  pure  com- 
pound of  medical  and  social  troubles,  with  the  emphasis  per- 
haps more  upon  the  social  than  the  personal  side. 

The  case  of  Miss  Jackson  we  found  more  or  less  the  vehicle 
of  all  the  major  sorts  of  evil  that  we  tried  to  classify  under 
the  five  headings  of  disease  {Morhi),  ignorance  {Err ores), 
vices  and  bad  habits  (Vitia),  legal  entanglements  (Litigia), 
and  poverty  or  other  forms  of  resourcelessness  (Penuriae). 
Studying  the  case  of  Henry  Loyal,  we  find  that,  as  in  the 
majority  of  instances  in  this  book,  he  is  the  victim  of  disease; 


26  THE    KINGDOM    OF    EVILS 

at  all  events,  of  a  degree  of  psychopathy  that  is  sufficient  to 
bring  him  into  all  sorts  of  personal  and  social  difficulty.  Shall 
we  charge  him  also  with  being  the  victim  of  the  evil  we  call 
ignorance?  We  found  him  on  the  verge  of  feeble-mindedness 
by  tests,  but  the  psychologists  felt  that  on  the  whole  he  must 
be  regarded  as  of  normal  mental  level.  He  was  neither  a  good 
nor  a  poor  scholar.  He  was  an  adequate  steamfitter.  He 
proved  amenable  to  persuasion  if  not  to  conviction,  and  no 
elaborate  reeducation  or  implantation  of  totally  new  ideas  had 
to  be  carried  out  in  the  process.  His  sex  irregularities  cannot 
on  the  whole  be  said  to  be  due  to  ignorance  or  poor  intellectual 
training.  On  the  whole,  there  was  a  good  deal  to  go  upon 
in  the  practical  handling  of  Henry  Loyal,  and  we  must  count 
him  as  not  falling  to  any  extent  into  the  evil-group  termed 
ignorance. 

Re  the  third  group  of  evils,  as  in  our  paradigm  case  of 
Agnes  Jackson,  so  in  the  present  case,  it  is  difficult  to  disengage 
the  bad  habits  and  vices  shown  from  effects  of  disease.  H  our 
separation  of  the  bad  habits  and  vices,  on  the  one  hand,  from 
the  diseases  and  character  defects  on  the  other,  is  a  logically 
sound  separation,  then  there  ought  to  be  some  cases  in  the 
world  of  persons  who  unfortunately  have  not  been  properly 
trained  and  given  the  proper  moral  set-up  in  life;  and  these 
persons  ought,  by  hypothesis,  not  to  be  instances  of  mental 
disease  or  defect.  Such  persons  ought  to  be  trainable  by  suit- 
able methods,  either  by  way  of  telling  them  or  showing  them 
what  to  do,  by  precept,  example,  reward,  or  punishment.  So 
far  as  mere  precept  and  mere  example  and  the  common  methods 
of  reward  and  punishment  were  concerned,  hardly  anything 
could  have  been  done  with  Loyal.  Punishment  would  no  doubt 
have  failed.  The  kind  of  reward  offered  was  the  pleasing  sense 
conveyed  to  him  of  increased  responsibility  for  a  family  to 
which  he  was  tremendously  though  interruptedly  devoted.  He 
was  made  to  feel  more  of  a  man.  That  Loyal  had  sundry  bad 
habits  and  vices  aside  from  his  psychopathia,  we  do  not  know 
for  certain.  But  whether  we  are  dealing  merely  with  psycho- 
pathic instability  or  with  the  eft'ects  of  poor  moral  training,  no 
doubt  the  plan  of  reeducation  is  at  first  identical  for  a  victim  of 
either  form  of  evil. 

Of  legal  entanglements,  our  first  paradigm,  Jackson,  was  a 
prime  example  in  that  she  was  an  "undesirable  immigrant." 


THE    KINGDOM    OF   EVILS  27 

Loyal's  succession  of  predicaments  for  the  most  part  failed  to 
lapse  into  the  legal  group,  though  he  was  in  court  four  times 
for  non-support  and  wife-beating.  The  wife  never  had  to 
appear  in  court  to  make  her  point,  and  his  official  friends  and 
supervisors  made  use  of  the  point  once  only,  when  he  was 
threatened  with  the  prospect  of  a  separation. 

How  far  can  the  Loyal  family  difficulties  be  regarded  as 
purely  economic?  That  is,  how  far  does  the  evil  in  question 
fall  into  the  group  of  poverty  and  other  forms  of  resourceless- 
ness?  We  said  that  if  the  Jackson  family  had  been  on  a  higher 
economic  level,  the  life  of  Miss  Jackson  would  not  have  been 
cast  in  its  peculiar  way  and  that  she  might  never  have  become 
an  immigrant,  desirable  or  otherwise.  What  can  be  said  of 
this  point  in  the  Loyal  case?  The  family  as  a  whole  is  on  a 
fairly  high  middle-class  level,  with  a  number  of  relatives  re- 
garded.as  well-to-do.  Some  non-psychopathic  relatives  are  suc- 
cessful in  their  professions.  The  courses  in  life  of  some  of 
the  psychopathic  relatives  indicate  that  their  economic  level, 
high  or  low,  has  little  to  do  with  the  behavior  adopted.  Hence 
the  social  treatment  of  this  case  or  of  the  Loyal  family  group 
^s  a  purely  economic  problem  would  quite  miss  the  point.  In 
point  of  fact,  Henry  Loyal  while  at  work  could  earn,  both 
before  and  during  war  time,  exceedingly  good  pay. 

We  shall  now  turn  to  a  few  further  details  of  the  case 
Loyal.  Note  should  be  taken  of  the  slow  and  slight,  but  steady, 
and  on  the  whole  uniform,  stabilizing  which  Loyal's  character 
is  undergoing.  Doubtless  he  would  have  to  live  several  lives 
tandem  to  get  sufficiently  stabilized  so  that  he  would  no  longer 
require  supervision ;  but  our  general  principle  of  hope  for  stabil- 
ization even  in  the  most  difficult  cases  remains  a  principle.  Our 
records  run  to  over  a  hundred  pages,  but  for  the  purpose  of 
this  exposition  we  will  limit  ourselves  to  a  few  of  the  more 
striking  episodes  in  the  Loyal  history. 

Loyal  first  came  to  the  Psychopathic  Hospital  on  the  advice 
of  a  social  worker  in  a  general  hospital  where  his  little  daughter 
was  under  treatment  for  chorea.  He  was  out  of  work  ai  the 
time  and  for  years  had  failed  to  support  his  family.  The  oldest 
girl  was  fifteen,  the  second  one,  who  was  choreic,  was  twelve, 
and  the  youngest  child,  also  a  girl,  was  five  years  old.  A 
fourth  girl  was  born  four  months  later.  At  this  time  the 
family  was  living  in  a  shack  on  the  outskirts  of  a  suburban 


28  THE    KINGDOM    OF    EVILS 

town,  and  their  economic  condition  was  acute.  On  the  ground 
that  there  might  be  a  nervous  cause  for  his  headaches,  which 
he  claimed  prevented  him  from  'working  steadily.  Loyal  was 
persuaded  to  come  to  the  out-patient  department  for  an  exam- 
ination and  even  consented  to  enter  the  hospital  for  a  week's 
observation. 

He  got  a  job  and  moved  to  a  good  neighborhood.  Some  of 
the  debts  were  paid  off,  and  a  much  coveted  piano  was  obtained 
on  the  installment  plan.  All  went  well  for  about  eight  months, 
when  Loyal  again  became  irregular  in  all  his  habits.  He  con- 
tracted gonorrhea  and  his  wife  became  infected.  Meanwhile, 
one  of  the  children  had  developed  a  tuberculous  hip,  required 
long,  patient  treatment  in  a  hospital,  and  was  later  boarded  out 
in  the  care  of  a  children's  agency.  Throughout  her  illness  Mr. 
Loyal  was  in  a  state  of  anxiety  and  excitement  which  threatened 
to  interfere  with  the  child's  proper  care,  but  in  the  end  the 
social  worker  prevailed  and  the  little  girl  made  a  good  recovery. 
The  second  child  recovered  from  her  attack  of  chorea  under 
the  exceptionally  good  nursing  given  her  by  her  mother.  The 
baby  too  was  sick,  but  not  seriously. 

Work  became  slack  and  the  landlady  threatened  prosecution 
for  arrears  of  rent.  From  time  to  time  it  was  necessary  to 
give  financial  assistance,  for  which  funds  were  given  anony- 
mously by  a  relative.  Finally  public  aid  had  to  be  sought.  In 
time,  Mr.  Loyal  found  new  work  on  government  buildings  and 
had  no  more  difficulty  in  getting  employment,  although  he  was 
likely  to  be  idle  for  short  periods  between  jobs.  It  was  never 
possible  to  find  out  what  he  did  with  the  high  wages  he  re- 
ceived. Certainly  the  results  were  not  evident.  In  one  of  these 
intervals  of  unemployment,  nearly  four  years  after  the  family 
became  known  to  us,  a  crisis  arose.  Mrs.  Loyal  was  sick  and 
in  need  of  hospital  care  (she  had  been  having  serious  trouble 
with  varicose  veins),  funds  were  exhausted,  and  the  landlord 
had  set  a  date  for  eviction.  Loyal  had  a  job  in  view,  but  could 
not  get  it  until  he  was  restored  to  good  standing  in  the  union. 
The  way  out  was  found  by  sending  one  of  the  girls  to  a  rela- 
tive, Mrs.  Loyal  to  a  hospital,  and  the  two  younger  children  to 
the  public  authorities  for  temporary  boarding-out.  The  oldest 
girl  by  this  time  was  married  to  a  man  considerably  older  than 
she,  a  distant  relative  with  some  means.  She  had  developed 
a  character  much  like  her  father's.    Nevertheless  with  the  fam- 


THE    KINGDOM    OF    EVILS  29 

ily  provided  for  and  his  financial  condition  revamped,  Mr. 
Loyal  started  for  his  new  job.  In  a  few  months  he  was  able 
to  take  the  children  from  public  care  to  their  mother,  who  went 
to  live  with  her  sister  in  a  city  near  the  scene  of  work.  At 
last  report,  he  and  his  wife  were  making  efforts  to  get  together 
■a  home  again. 

Hours  spent  by  Medical  record,  42  pages 

Social  record,  106  pages 
Physician,  15  Social  work : 

Visits,  120 
Psychologist,  i  Interviews  at  hospital,  57 

Telephone  calls,  105 
Social  worker,  245  Letters,  75 


Adventuress,  thief,  liar — psychopathic  persofiality.  Mental 
level  testing  very  high.  A  "public"  problem  in  hands  of  the 
law,  sent  for  observation  by  alienist. 

Case  5.  We  possess  numerous  newspaper  clippings  about 
the  possible  deportation  of  the  supposed  wife  of  a  famous 
British  army  officer.  "Lady"  Nora  Campbell  was  brought 
to  the  Psychopathic  Hospital  by  a  social  worker.  Mrs.  Camp- 
bell had  been  doing  voluntary  war  work.  Her  husband,  she 
said,  had  been  a  major  in  the  army,  killed  on  service  in  the 
war,  leaving  her  a  child,  which  about  six  months  since  had 
died  at  the  age  of  eighteen  months.  Now,  it  chanced,  she 
said,  that  she  was  the  goddaughter  of  the  King,  a  niece  of  a 
well-known  general,  had  given  from  her  ample  estate  a  hos- 
pital for  the  use  of  English  soldiers  and  had  had  some  seventy 
per  cent  of  her  money  taken  over  by  the  British  Government. 
She  said  at  one  time  that  she  was  the  illegitimate  child  of  a 
person  high  in  English  society,  who  was  paying  her  seven 
thousand  pounds  a  year  as  sort  of  hush  money.     , 

From  various  physicians  and  Boston  people  with  whom  the 
patient  had  had  dealings,  a  number  of  stories  were  collected 
concerning  Mrs.  Campbell.  The  biggest  story  hung  upon  the 
loss  of  a  brooch  by  a  fellow  war  worker,  who  had  known  her 
for  two  or  three  months  and  regarded  her  as  a  quiet,  ladylike 
victim  of  the  war  who  was  only  to  be  pitied  for  her  wanderings, 
the  loss  of  her  husband  and  baby,  and  her  present  loneliness. 
To  be  sure,  Mrs.  Campbell  it  seems  had  flirted  with  a  son  of 


30  THE    KINGDOM    OF    EVILS 

one  of  the  war  workers,  and  had  on  sonae  pretext  obtained 
twenty  dollars  from  him.  There  also  was  a  somewhat  unlikely 
story  about  a  man's  coming  to  get  two  hundred  dollars  hush 
money  and  making  away  with  eight  hundred  dollars  more  which 
was  in  her  purse.  Finally,  a  valuable  brooch  disappeared  under 
very  suspicious  circumstances,  and  shortly  thereafter  Mrs. 
Campbell  tried  to  sell  a  brooch  on  account  of  its  "evil  associa- 
tions." Detectives  were  finally  called  in.  Several  inconsistent 
stories  were  told  them.  In  the  end  the  brooch  was  found,  and 
after  sundry  vicissitudes,  also  the  central  stone,  which  at  one 
time  Mrs.  Campbell  tried  to  isolate  by  burying  it. 

The  eventual  diagnosis  from  the  psychopathic  point  of  view 
in  the  case  of  Mrs.  Nora  Campbell  was  that  of  psychopathic 
personality,  a  phrase  intended  to  convey  the  idea  that  she  was 
not  a  mere  delinquent  but  that  her  tendencies  were  in  large 
part  psychopathic.  Of  course,  there  were  numerous  and  sun- 
dry defense  reactions  of  the  true  delinquent  in  Mrs.  Campbell, 
who  told  many  forms  of  tales  and  lied  more  or  less  expertly  on 
all  occasions  (never,  even  in  the  end,  confessing  her  theft  of 
the  brooch)  about  her  life  and  status.  Physically,  there  was 
no  certain  evidence  of  there  having  been  a  child  born,  and 
conditions  were,  on  the  whole,  rather  consistent  with  the  idea 
that  no  such  obstetric  history  could  ever  have  occurred.  The 
physical  examination  proved,  in  fact,  to  be  practically  normal 
in  all  respects. 

Psychologically,  she  rated  extremely  high,  achieving  95 
points  in  a  possible  100.  She  did  many  of  the  tests  exception- 
ally well,  was  perhaps  somewhat  over-suggestible  and  fell  off 
particularly  in  certain  performance  tests.  Whether  or  not  on 
account  of  her  intentional  and  unintentional  lying,  she  gave  the 
impression  of  a  slight  memory  defect. 

The  case  of  Nora  Campbell  is  schematically  simple.  To  be 
sure,  from  one  point  of  view,  if  Mrs.  Campbell  was  a  psycho- 
path, then  it  is  clear  that  we  must  logically  conceive  that  she 
possessed  "individual  difficulty."  There  is  presumably  no 
psychopath  who  is  not  a  "damaged  individual."  In  the  first 
place,  there  remains  judicial  doubt  and  also  doubt  in  the  lay 
mind  whether  this  adventuress,  liar,  and  thief  was  really  a 
psychopath  at  all.  For  example  (the  judge  or  the  layman 
might  say)  an  adventuress,  thief,  and  liar  might  be  such  from 
faulty  education,  as  the  criminals  taught  by  Fagin  in  Oliver 


THE    KINGDOM    OF    EVILS  3 1 

Twist  were  victims  of  faulty  education  rather  than  of  disease 
or  moral  deficiency.  So  it  might  be  that  Mrs.  Nora  Campbell 
had  been  educated  under  conditions  which  made  a  life  of  ad- 
venture with  the  fleecing  of  society,  subject  to  the  accompani- 
ment of  picturesque  lying,  a  natural  career  for  a  woman.  Ad- 
mittedly, this  would  be  doubtful,  but  the  hypothesis  must  neces- 
sarily be  entertained,  if  only  to  be  dismissed.  A  far  more 
likely  hypothesis  concerning  the  intra-individual  blemishes  of 
Mrs.  Campbell  would  be  that  she  was  a  vicious  person,  a  per- 
son of  faulty  mental  and  moral  habits  who  had  slipped  into  a 
life  of  crime  of  this  "grafting"  sort  more  than  half  intention- 
ally. Such  a  hypothesis  would,  no  doubt,  fit  a  good  deal  of 
what  we  term  crime  (in  the  minds  of  the  laity). 

However  all  this  may  be,  the  point  in  not  classifying  Nora 
Campbell  as  a  case  in  the  "individual"  group  is  that  she  did  not 
fall  under  the  sphere  of  authority  which  deals  with  the  indi- 
vidual as  such.  She  was  and  remained  an  almost  purely  legal 
case,  despite  the  fact  of  her  observation  at  the  Psychopathic 
Hospital  under  much  more  lax  conditions  than  most  com- 
munities permit. 

Should  we  not  classify  Mrs.  Campbell  as  falling  under  the 
sphere  of  social  influence  or  authority?  To  be  sure,  many 
interested  society  people  and  many  social  workers  became  inter- 
ested in  her  and  spent  some  time  upon  her  devious  ways. 
Nevertheless,  throughout  the  whole  situation,  the  hand  of  the 
law  and  the  penetrative  technique  of  the  detective  drew  the  red 
herring  of  public  influence  over  all  the  social  and  individual 
interests  which  might  otherwise  have  prevailed.  The  point  for 
the  general  or  psychiatric  social  worker  to  bear  in  mind  is  that, 
whatever  may  be  the  medical  information  concerning  the  pro- 
found and  delicately  balanced  psychopathic  interior  of  the  case, 
nevertheless  a  case  like  Campbell  is  without  the  range  of  the 
physician  to  influence  thoroughgoingly,  simply  because  the  iron 
of  the  situation  remains  in  the  hand  of  the  law.  Again,  what- 
ever the  social  worker  may  think  as  to  the  excellence  of  her 
own  technique  in  managing  a  case  like  Campbell,  she  must 
always  remember  that  the  case  remains  one  under  public  author- 
ity. She  may  supply  a  good  deal  of  velvet  for  the  outside  of 
the  glove,  but  the  iron  remains  therein.  Upon  whatever  logical 
or  profoundly  sentimental  grounds  the  physician  or  the  social 
worker  may  want  to  proceed,  he  or  she  is  forthwith  stopped, 


32  THE    KINGDOM    OF   EVILS 

in  all  authoritative  procedure,  by  the  hand  of  the  law.  There 
are  public  interests  here  which  are  organized  and  crystallized 
from  the  habits  of  centuries  on  the  part  of  the  legal  world. 
These  old,  crystallized  judicial  and  institutional  habits  must 
prevail  until  they  are  bowled  over  or  turned  into  dead  letters 
by  the  new  knowledge  which  may  accrue  in  future  systematic 
studies  of  delinquency  and  near-delinquency. 

We  concede  that  we  have  presumably  no  right  to  draw  such 
heavy  conclusions  as  the  above  from  the  case  of  the  adventuress 
Campbell.  Throughout  the  rest  of  the  book,  however,  we  shall 
find  these  public  interests  interwoven  through  the  social  and 
individual  interests  that  we  are  tempted  to  think  ought  often 
to  have  the  right  of  way.  The  interests  of  the  state  as  a  juris- 
tic person  and  the  interest  of  the  state  as  guardian  of  social 
interests  (phrases  of  Dean  Roscoe  Pound)  are  interests  often 
paramount  to  the  individual  interests  in  personality,  domestic 
relations,  and  economic  circumstances,  and  paramount  over 
such  general  social  interests  as  the  security  of  social  institu- 
tions, the  maintenance  of  general  morality,  the  conservation 
of  social  resources  and  general  progress — all  of  these  phrases 
borrowed  from  a  legal  statement  of  certain  fundamental  con- 
ceptions of  the  "legal  order."  "The  legal  order,"  writes  Dean 
Pound,  is  "an  adjustment  of  human  actions  and  relations  in 
order  to  conserve  the  goods  of  existence,  prevent  friction  in 
human  use  and  enjoyment  of  these  goods,  and  eliminate  waste 
of  them."  In  the  case  of  Campbell,  it  is  a  question  of  a  brooch, 
borrowings  of  money,  etc.,  an  enormous  waste  of  good  people's 
time,  and  a  question  of  prevention.  Aside  from  imprison- 
ment, it  must  be  granted  that  the  legal  order  does  not  seek  the 
methods  of  prevention  that  social  workers  and  physicians 
would  be  eager  to  establish.  Punishment  and  redress  are  far 
more  prominent  in  the  legal  order  than  prevention.  But  that 
is  another  story  and  one  calculated  to  be  extraordinarily  devel- 
oped by  a  systematic  attack  on  the  problems  of  general  and 
psychiatric  social  work. 

Hours  spent  by  Medical  record,  6i  pages 

Social  record,  9  pages 
Physician,  9  Social  work : 

Visits,  4 
Psychologist,  I  Interviews  at  hospital,  I 

Telephone  calls,  3 
Social  worker,  9  Letters,  15 


ALCOHOLIC  PSYCHOSIS 

IN  A  PACKER 

November,  1915  November,  ipi6 

Inebriety  Sobriety 

Unemployment  Steady  Work 

Physically  Disabled  Good  Health 

No  Income  Good  Wages 


After-care  of  an  alcoholic.  Rationalisation.  Point  of  view 
of  a  hospital  organization  knozvn  as  tlw  Men's  Club.  Non- 
psychiatric  social  ivorker  likely  to  miss  the  point  of  such  a 
case.  Patient  now  better  than  lie  ever  was.  Problem  social, 
rather  than  public  or  individual  in  the  special  senses  of  those 
terms. 

Case  6.  Alfred  Mack,  an  Irish  elevator  man,  is  now  al- 
most forty  years  old.  We  describe  him,  with  some  misgivings, 
as  a  paradigm  of  social  troubles,  occurring  practically  pure, 
that  is,  without  any  public  (governmental)  complications  and 
without  special  medical  difficulties.  Mack  was  under  our  social 
supervision  for  some  three  years.  A  recent  inquiry  has  shown 
him  socially  adequate,  after  a  period  of  about  five  years  since 
the  medical  incidents  that  brought  him  to  the  hospital. 

Possibly  the  layman  would  not  regard  the  episodes  which 
brought  him  to  the  Psychopathic  Hospital  as  mere  "incidents," 
since  he  there  got  a  definite  diagnosis  of  mental  disease,  due  to 
alcoholism,  and  since  doubts  were  there  raised  as  to  whether 
he  might  not  be  a  victim  of  very  severe  mental  disease  leading 
possibly  to  deterioration.  No  such  deterioration  has  set  in. 
The  mental  tests,  in  point  of  fact,  yielded,  five  years  ago, 
according  to  the  Yerkes  Point  Scale,  an  age  level  of  fifteen 
years  plus.  It  is  true  that  the  Binet  tests  left  him  at  an  eleven 
year  level  at  the  time  he  was  first  examined;  but  the  psycho- 
logical examiners  even  then  attributed  his  deficiency  to  the 
alcoholic  traces  which  he  still  showed. 

The  alcoholic  mental  disease,  severe  as  it  was  (he  had  definite 
delusions  of  persecution  and  even  hallucinations  of  hearing, 
possibly  of  vision)  ended  in  a  relatively  perfect  recovery,  so 
that  he  could  be  discharged  recovered  in  nineteen  days.  Ac- 
cording to  the  usual  psychopathic  hospital  technique,  Mack 
was  discharged  to  the  out-patient  department  of  the  hospital, 
where  he  has  since  been  carried  on  the  books. 

Upon  a  further  study  of  his  situation,  another  bothersome, 
but  rather  banal  medical  condition  was  drawn  into  the  fore- 
ground. He  had,  for  a  number  of  years,  had  ulcers  of  his  feet 
which  had  been  variously  treated  in  general  hospitals  and  which 

35 


36  THE    KINGDOM    OF    EVILS 

have  left  him,  up  to  date,  quite  unable  to  do  certain  kinds  of 
work.  At  various  times  a  packer  and  a  shipper's  assistant,  he 
has  finally  settled  into  being  an  elevator  man.  (As  to  actual 
nature  of  the  disorder  of  his  feet  there  is  doubt.  The  ulcers 
were  apparently  treated  at  one  time  as  syphilitic,  but  our  blood 
tests  proved  negative  in  this  regard.  On  the  whole,  the  dis- 
order seems  to  be  almost  purely  orthopedic.) 

Far  more  serious  than  the  severe,  acute  episode  of  mental 
disease  through  which  he  was  carried,  and  of  less  consequence 
than  the  orthopedic  disorder  just  noted  seemed,  at  first  blush, 
his  twenty  years'  history  of  alcoholism. 

Mack  was  a  somewhat  appealing  little  man,  looking  rather 
old  for  his  years,  with  a  pigeon  breast,  trouble  with  both  arches 
of  his  feet,  and  poor  teeth.  A  study  of  his  heredity  left  one 
much  concerned  for  his  outcome.  Both  parents  (the  mother, 
a  Roman  Catholic,  had  married  a  Church  of  England  father) 
were  alcoholic,  and  the  father  died  of  cirrhosis  of  the  liver,  the 
mother  of  paralysis  following  five  years  "of  being  peculiar 
after  her  first  stroke." 

The  father  had  been  a  sex  delinquent  and  nothing  was  known 
of  his  brothers  and  sisters  if,  indeed,  there  were  any.  The 
mother's  brothers  and  sisters  were  all  alcoholic,  two  dying  of 
paralysis  (one  of  the  aunts  had  a  kind  of  mental  disorder  at 
menopause  and  died  at  a  hospital  for  the  insane  after  a  para- 
lytic stroke  in  the  sixties).  It  is  difficult  to  choose  a  general 
epithet  for  the  family,  whether  "alcoholic,"  "paralytic,"  or 
"cardiac,"  though  possibly  these  conditions  are  in  this  particu- 
lar family  closely  interrelated.  Nevertheless,  Alfred  Mack,  him- 
self alcoholic  and  given  inordinately  to  tobacco,  despite  his 
somewhat  melancholic  self-depreciative  and  rather  unsocial 
frame  of  mind,  was  always  considered  a  man  of  normal  in- 
telligence and  a  fair  worker.  He  held  his  first  position  for 
eighteen  years  and  was  not  known  by  his  employer  to  be  the 
steady  alcoholic  that  he  really  was.  He  may  have  been  held 
in  this  position  somewhat  out  of  pity  for  himself  and  his 
mother,  whom  he  helped  to  support  for  ten  years.  The  rheu- 
matism and  ulcers  of  the  toe  were  said  to  have  followed  a 
severe  attack  of  scarlet  fever  in  childhood.  There  is  history 
of  a  supposed  concussion  of  the  brain  from  a  fall  at  the  age 
of  seventeen.  (The  psychiatrist  is  apt  to  think  of  such  con- 
cussion cases  as  subject  to  unusual  intolerance  for  alcohol.) 


THE    KINGDOM    OF    EVILS  37 

There  is  a  still  more  obscure  history  of  a  supposed  love  affair 
in  the  teens,  but  for  the  rest  of  the  patient's  life,  at  least,  he 
showed  no  interest  in  girls,  had  a  few  male  chums,  but  was 
never  "hail  fellow,  well  met." 

In  his  thirty-fifth  year.  Mack  had  an  attack  which  it  would 
seem  safe  to  describe  as  one  of  delirium  tremens.  The  second 
attack,  which  came  on  at  a  general  hospital  to  which  he  had 
reported  for  an  operation  on  his  foot,  brought  him  to  the 
Psychopathic  Hospital. 

Up  to  the  time  of  development  of  the  first  attack  called 
delirium  tremens,  there  appears  to  have  been  no  sign  of  mental 
or  nervous  disorder  save  that,  apparently  at  about  the  age  of 
thirty-two,  he  once  had  a  sudden  attack  of  blindness  lasting  a 
quarter  of  an  hour.  For  the  rest,  in  early  life  he  may  or  may 
not  have  had  certain  fainting  fits  in  the  course  of  the  "rheu- 
matism" which  followed  his  scarlet  fever. 

In  this  analysis  we  are  intentionally  overemphasizing  and 
throwing  into  relief  sundry  minor  points  in  Mack's  medical 
history  with  the  idea  of  showing  that  the  main  complications 
which  social  treatment  had  to  face  were  either  not  medical  or 
else  were  perfectly  obvious  matters  to  deal  with.  In  short,  if 
we  are  searching  for  a  case  of  practically  pure  social  difficulty 
and  confine  ourselves  to  drawing  upon  hospital  cases,  we  shall 
rarely  find  a  purer  instance  of  social  difficulty  without  public 
complications  and  with  rather  obvious  medical  indications. 

Let  us  contrast  the  problems  as  they  faced  the  medical  man 
and  the  social  worker  respectively.  The  physician  confronted 
a  rather  prematurely  aged  alcoholic  of  twenty  years'  standing 
who  had  had  two  rather  serious  attacks  of  an  acute  mental 
disease  due  to  alcohol.  The  heredity  was  in  several  respects 
poor  and  the  stock  in  general  given  to  disease  of  the  blood 
vessels.  The  situation  was  complicated  by  rheumatism,  ulcers, 
and  some  obscure  though  slight  nervous  phenomena,  appar- 
ently attributable  to  a  severe  scarlet  fever  in  childhood.  The 
general  medical  indications  were  merely  those  of  proper  hygiene 
(possibly  with  special  reference  to  work  that  might  spare  the 
heart). 

Confronting  Mack's  case  in  the  same  general  way,  the  social 
worker  found  him  on  a  basis  of  (a)  inebriety,  (&)  a  case  of  un- 
employment of  about  a  year's  duration,  and  hence  (c)  without 
income  and  even  possibly  (d)  disabled  industrially. 


38  THE    KINGDOM    OF    EVILS 

As  for  the  industrial  disability  of  orthopedic  origin,  the  cure 
was  relatively  easy,  and  general  hospital  care  soon  helped  his 
feet  so  that  he  could  undertake  a  new  job  as  elevator  man. 
Meantime,  until  the  disability  for  work  could  be  removed,  small 
sums  of  money  were  got  for  him   (this  the  very  well-inten- 
tioned man  later  repaid)  and  the  next  step  was  to  get  him  an- 
other permanent  job.     As  the  man's  general  nature  was  such 
that  he  liked  to  work  in  one  place   (his  "occupational  orbit" 
was  very  small)  and  as,  moreover,  the  foot  trouble  helped  de- 
fine the  issue,  it  was  fitting  that  he  should  go  back  to  an  ele- 
vator job.     But  the  desirable  permanent  job  did  not  come  until 
he  had  tried  several  temporary  ones.     Yet  to  remove  the  foot 
trouble,  tide  him  over  his  convalescence  and  to  get  him  a  job, 
was  not  to  abolish  his  inebriety.    For  this  purpose  he  was  com- 
pliant with  a  plan  of  coming  to  the  so-called  "Men's  Club" 
which  ran  at  the  Psychopathic  Hospital  for  several  years  (up 
to  war  emergencies)  and  was  a  most  effective  agency  for  hold- 
ing certain  recovered  alcoholics  to  a  program  of  abstinence  or 
temperance.     Mack  took  no  especially  prominent  part  in  club 
meetings,  but  drank  his  coffee  and  ate  his  cake  with  the  other 
social  convalescents  every  evening  after  the  club  business  was 
discussed,  namely — how  to  beat  inebriety.     The  Psychopathic 
Hospital  Men's  Club  would  be  worth  a  detailed  elaboration  as 
an  interesting  application  of  the  class  method  in  psychotherapy. 
Mack  was  simply  "one  of  the  boys"  at  these  meetings,  which 
were  presided  over  by  convalescents  elected  to  their  jobs  and 
run  in  the  presence  of  a  social  worker  or  two.     From  month 
to  month  the  program  of  the  meetings  varied,  but  as  a  rule 
some  physician  would  help  lead  the  attack  on  alcohol.     A  deep 
analysis  of  the  operations  of  such  a  club  would  have  to  take 
into  account  the   frequent  successes  of   a  psychotherapy    for 
alcoholism  which  did  not  utilize  music,  religion,  or  even  ethics 
in  the  common  manner  of  so-called  "uplift."     In  fact,  a  plain 
rationalization  of  the  alcoholic's  plight  was  the  mainstay  of 
these  meetings  where  each  man's  endeavor  was  to  some  extent 
bolstered  by  a  certain  sense  of  competition  with  his  brother 
convalescents.    As  for  spiritual  appeal,  the  case  of  Alfred  Mack 
might  have  been  difficult.    With  a  Roman  Catholic  mother  and 
a  Church  of  England  but  sexually  delinquent  father,  a  boy  who 
had  been  embraced  rather  than  guided  into  the  Baptist  church 


THE    KINGDOM    OF    EVILS  39 

was  no  specially  suitable  vessel  for  spiritualization,  unless  in- 
deed some  complete  conversion  could  have  been  undertaken. 

The  elements  in  getting  hold  of  a  case  like  Mack's  were  not 
complex.  To  adjust  the  simple  medical  care,  to  get  him  a 
little  money  in  the  meantime,  and  to  get  him  temporary,  and 
at  last  permanent  jobs,  to  rationalize  and  support  a  proper  at- 
titude (through  the  Men's  Club)  to  alcoholism,  were  measures 
to  which  but  one  other  had  to  be  added.  It  was  necessary  to 
secure  and  maintain  a  proper  attitude  on  the  part  of  Mack's 
family  to  his  history  and  his  outlook.  This  family  consisted 
of  a  sister  and  her  husband.  The  brother-in-law  was  not  a 
drinking  man  and  was  friendly  to  Mack.  It  did  not  take  long 
to  patch  everything  properly  up.  It  is  worth  noting  that  the 
patient's  sister  had  herself,  at  one  time,  been  a  charity  case  on 
account  of  the  drinking  habits  of  her  mother.  But  married,  as 
she  finally  was  to  a  non-alcoholic  painter,  she  herself  had  made 
what  might  be  called  a  social  recovery.  All  of  which  leads 
one  to  ponder  upon  the  entire  family  background  of  the  Mack 
case  which,  absolutely  black  as  it  was  from  alcoholism  and 
tendencies  to  blood-vessel  disease,  nevertheless  gave  room  for 
successful  social  measures. 

We  must  not  say  that  the  insight  of  the  psychiatric  social 
worker  is  extraordinarily  more  penetrative  in  a  case  like  Mack's 
than  that  of  the  medical  social  worker  approaching  the  problem 
from  more  general  ground.  Nevertheless  we  think  it  safe  to 
say  that  many  a  case  with  as  black  a  heredity  and  family  back- 
ground, a  history  of  years  of  social  failure,  might  well  drop 
into  the  discard  in  the  presence  of  ever  so  many  more  "prom- 
ising" cases.  Of  course  one  does  not  know  what,  for  example, 
the  orthopedic  division  of  a  social  service  department  would 
have  accomplished  for  Mack.  It  is  a  little  bizarre,  yet  profit- 
able, to  think  that  without  an  attack  of  outspoken  alcoholic 
mental  disease.  Mack  might  thus  have  been  handled  by  an 
orthopedic  social  worker  after  a  successful  course  of  foot  treat- 
ment at  a  general  hospital.  It  is  a  question  whether  his  alco- 
holism would  have  been  handled  as  intensively  as  the  Men's 
Club  allowed  it  to  be  handled  at  the  Psychopathic  Hospital. 
Perhaps  we  unduly  malign  the  non-psychiatric  social  worker  in 
the  above  reflection,  but  it  seems  safe  to  say  that  without  a 
good  bit  of  experience  with  the  temperaments  of  alcoholics 


40  THE    KINGDOM    OF    EVILS 

and  of  more  pronounced  psychopaths,  the  routine  social  worker 
of  economic  bent  or  with  the  everyday  philanthropic  point  of 
view  would  scarcely  be  tempted  out  of  the  ordinary  run  of 
measures.  The  concrete  thing  which  the  psychiatric  social 
worker  here  did  was  to  utilize  the  Men's  Club  for  rationalizing 
the  patient's  outlook  on  life,  but  more  than  that,  to  employ  the 
entire  fundamental  plan  of  attack  which  underlies  the  Men's 
Club  and  all  other  social  psychiatric  measures — namely,  the 
temperamental  or  characterological  point  of  attack.  To  be 
sure,  any  human  being  with  insight  into  human  nature  and 
considerable  experience  therein  might  have  seen  through  the 
slight  unsociableness  of  the  patient,  marked  out  his  native 
timidity  as  an  avenue  of  approach,  and  fed  his  waning  self- 
respect  in  a  variety  of  ways. 

We  cannot  claim  that  the  church  has  not  accomplished  as 
much  or  more  with  equally  alcoholic  patients.  But  the  church 
would  probably  have  been  of  lesser  service  in  this  man  of  mixed 
religious  antecedents.  Nor  do  we  deny  that  the  technique  of 
conversion  or  regeneration  by  the  process  of  the  "twice  born 
men"  would  have  been  applicable.  The  social  psychiatric  ques- 
tion is,  as  the  child  W.  K.  Clifford  used  to  say,  "What  is  the 
particular  go  of  itf"  At  all  events,  whatever  the  technique, 
we  can  safely  say  that  Mack  is  at  this  time  medically  a  much 
sounder  unit  in  the  world  than  he  was  at  the  time  of  his  alco- 
holic psychosis  and  for  many  years  preceding.  Whether  on 
the  account  of  the  social  treatment  or  by  reason  of  unknown 
factors,  there  has  been  a  decided  up-gradient  in  Mack's  life. 
For  years,  during  his  early  employment,  he  was  something  of 
an  object  of  pity  and  might  have  been  thrown  completely  out 
of  employment  had  his  steady  alcoholism  been  known.  Now 
Mack  is  one  of  the  most  reliable  and  efficient  minor  employees 
in  a  big  shop. 

We  need  no  extended  analysis  in  the  case  of  Mack  to  show 
how  the  major  sorts  of  evil  that  we  have  classified  in  the  pre- 
vious cases  fall  out.  Into  the  class  of  diseases  readily  fall  the 
tendency  to  blood-vessel  disorder,  rheumatism,  and  other  effects 
of  scarlet  fever,  and  more  probably  (although  not  demon- 
strable) a  certain  tendency  of  mind  which  naturally  led  him 
into  alcoholism.  With  such  a  heredity  as  Mack's  it  would  be 
impossible  to  deny  that  there  was  not  at  least  more  latent 
tendency  to  disease  in  him  than  in  the  majority  of  men. 


THE    KINGDOM    OF   EVILS  4I 

Turning  to  the  matter  of  ignorance  or  errors  of  education, 
we  find  Mack  singularly  free  from  these.  To  be  sure,  two 
parents  not  agreeing  upon  religion  probably  gave  him  little 
enough  of  true  home  education  or  moral  training.  Despite 
these  lacks,  the  man  is  relatively  free  of  their  concrete  effects. 
A  long  controversy  might  be  waged  as  to  whether  Mack's 
alcoholism  was  a  vice  or  a  bad  habit  into  which  he  was  led 
by  nature  on  one  hand  or  by  imitation  on  the  other.  The  pres- 
ent tendency  is  to  underscore  the  hereditary  standpoint  and  to 
scout  somewhat  the  factor  of  mere  imitation  of  parental  ideas 
and  habits.  As  to  the  tentacles  of  the  law,  Mack  failed  to  be 
caught  thereby,  save  in  the  benign  circumstances  that  the  tem- 
porary care  law  (that  mildest  of  all  legal  adventures  for  the 
psychopath)  became  available  when  he  was  out  of  his  head  at 
the  general  hospital.  The  existence  of  such  a  law  as  the  tem- 
porary care  law  (see  Appendix  C)  is,  no  doubt,  of  extraordi- 
nary importance  in  the  potentialities  of  social  service  for 
psychopaths  and  psychopathic  suspects  in  any  community.  But 
that  is  another  story. 

As  for  the  fifth  group  of  evils  which  we  have  discussed,  the 
economic  factor  was  drawn  only  temporarily  into  view.  We 
are  dealing  then  with  an  almost  purely  social  case  whose  minor 
complications  are,  to  be  sure,  medical,  but  whose  central  fea- 
ture, the  alcoholic  tendency,  must  be  regarded  as  a  kind  of 
psychopathic  tendency,  whose  effects  are  distinctly  curable. 
This,  indeed,  is  a  frequent  lay  point  of  view  toward  the  alco- 
holic unfortunate.  It  does  not  do  to  throw  the  alcoholic  out 
at  the  door,  even  if  his  history  be  a  long  and  sad  one  and  his 
hereditary  taint  even  more  terrible. 

We  must  here  leave  the  large  question  of  temperament  un- 
analyzed.  Below  we  shall  meet  many  instances  of  a  more 
striking  temperamental  make-up  which  the  disease  itself  will 
have  brought  out  in  exceeding  sharp  relief. 

Hours  spent  by  Medical  record,  36  pages 

Social  record,  15  pages 
Physician,  4  Social  work : 

Visits,  12 
Psychologist,  I  Interviews  at  hospital,  5 

Telephone  calls,  6 
Social  worker,  23  Letters,  15 


42  THE    KINGDOM    OF   EVILS 


Industrial  injury  (shell-shock  analogue  from  civilian  life). 
Looked  highly  ''organic."  Problem  chiefly  individual:  the 
mans  relation  to  himself.     Resentful  of  sympathy. 

Case  7.  James  Bailey,  a  Jewish  laundryman,  twenty-four 
years  old  when  he  was  first  seen,  is  presented  as  a  case  of  almost 
purely  medical  interest,  whose  social  aspects  (both  from  the 
standpoint  of  diagnosis  and  from  the  standpoint  of  treatment) 
were  of  an  obvious  nature  and  who  presented  no  public  serv- 
ice aspects  whatever,  (his  coming  voluntarily  to  an  out-patient 
clinic  in  the  Massachusetts  State  Hospital  system  may  be  re- 
garded as  putting  him  in  contact  with  governmental  agencies : 
and  his  damage  case  against  the  Elevated  Railway  was  in  the 
hands  of  a  lawyer). 

Medically  speaking,  James  Bailey  was  a  rather  intriguing 
case,  since  his  disorder  not  only  followed  a  definite  street  rail- 
way accident,  but  also  looked  to  the  neurologist  like  an  "or- 
ganic" case.  Yet,  Bailey's  nervous  system  was  really  reacting 
(as  was  eventually  determined)  to  a  tuberculous  pleurisy.  This 
pleurisy,  we  came  to  think,  formed  a  perfectly  genuine  nucleus 
of  pain  in  the  back,  around  which  the  peculiar,  at  first  sight 
"organic,"  disorder  crystallized. 

It  was  somewhat  with  Bailey's  case  as  with  sundry  shell- 
shock  hysteria  cases  of  the  war  group,  in  that  there  was  a 
genuine  focus  of  pain  of  organic  origin  around  which  the 
functional,  and  perfectly  curable,  disease  grew.  Many  func- 
tional disorders  of  the  back  and  legs  in  the  war  neurosis  group 
have  apparently  developed  in  precisely  this  way  around  strained 
ligaments,  small  hemorrhages,  or  other  lesions  incidental  in 
the  strains,  falls,  or  "windage"  of  war  service. 

Here,  then,  we  were  dealing  medically  with  a  "shell-shock 
analogue" ;  but  the  military  factor  in  the  situation  is  replaced 
by  a  pleurisy  which  was  perhaps,  although  not  certainly, 
lighted  up  by  the  railway  accident.  Curiously  enough,  Bailey 
developed  his  peculiar  gait  and  reactions  (somewhat  at  first 
sight  resembling  an  ataxic  paraplegia)  in  camp.  For  Bailey, 
about  a  month  after  his  railway  accident,  in  which  two  ribs 
were  fractured  in  alighting  from  a  car,  was  drafted  into  the 
United  States  Army  and  sent  to  camp.  Six  weeks  later  he  had 
to  be  discharged  on  the  ground  of  physical  disability,  as  he 


THE    KINGDOM    OF   EVILS  43 

could  not  keep  up  with  the  drilHng  and  dragged  his  foot.  It  is, 
of  course,  post  facto  obvious  that  Bailey  should  not  have  been 
accepted  for  military  service.  Yet  even  in  the  light  of  these 
subsequent  developments,  the  draft  board  physician  now  as- 
sures us  that  there  was  certainly  nothing  demonstrable  about 
the  man  which  could  possibly  have  led  to  his  rejection  as  a 
draftee. 

We  present  this  case  as  an  almost  purely  medical  case.  The 
social  work  of  the  case  might  be  characterized  as  supportive, 
as  a  sort  of  splint  to  Bailey's  will,  to  keep  him  in  contact  with 
medical  officers  who  only  could  cure  him. 

Bailey  is  of  rather  a  refined  and  meticulous  nature.  Al- 
though a  laundry  worker  in  this  country,  he  had  been  a  teacher 
in  Russia  (whence  he  had  emigrated  at  the  age  of  nineteen) 
and  had  nourished  ambitions  to  become  a  physician.  With 
characteristically  racial  intensity,  he  had  tried  to  improve  his 
status  in  the  world,  had  studied  hard  and  gone  to  evening 
school.  It  appears  that  his  mother  was  a  worrier,  or  as  one 
might  technically  say,  somewhat  "psychasthenic."  She  also 
had  the  history  of  developing  at  one  time  a  paralysis ;  whether 
this  was  of  hysterical  nature  or  not  is  unknown.  The  ambi- 
tions for  medicine  were  interfered  with  by  the  accident,  and 
Bailey  lost  some  of  his  savings.  The  army  service  set  him 
further  back.  He  was  now,  as  one  might  say,  on  the  defensive 
and  in  the  passive  voice.  He  felt  that,  after  all,  he  was  not 
entitled  to  sympathy  and  resented  any  signs  of  it  in  others. 
Bailey  looked  with  suspicion  on  jobs  suggested  for  him  be- 
cause he  did  not  want  to  take  a  "charitable"  job. 

Upon  the  examination  table  his  lameness  and  peculiar  posture 
of  back  and  legs  were  no  longer  in  evidence.  The  whole  situa-. 
tion,  with  the  exception  of  the  hypothesis  of  something  "peri- 
organic"  (the  pleuritic  pain  above  mentioned)  seemed  to  the 
physicians  hysterical. 

Bailey  is  now  somewhat  better ;  his  condition  is  theoretically 
curable.  The  function  of  the  social  service  is  to  keep  him  in 
contact  with  the  sources  of  proper  psychotherapeutic  sugges- 
tion. The  black  side  of  the  problem  is  merely  that,  after  all, 
he  has  a  definite  tuberculous  condition  of  his  pleura.  This 
can,  no  doubt,  be  cured,  whereupon  the  whole  hysterical  situa- 
tion would  have  no  longer  any  possible  organic  basis.  But,  if 
we  are  to  give  him  the  regime  suitable  to  a  case  of  tubercle. 


44  THE    KINGDOM    OF    EVILS 

we  must  clearly  somewhat  alter  his  mental  attitude,  which, 
though  unlike  that  of  his  worrying  mother,  is  of  a  somewhat 
psychasthenic  trend.  After  all,  the  relation  of  the  patient  to 
himself  is  the  most  important  point  here. 

We  thus  conclude  our  exposition  of  seven  cases  chosen  to 
illustrate  the  three  major  spheres  of  mental  hygiene,  public, 
social,  and  individual,  into  which  psychiatric  cases  (as  well, 
doubtless  as  all  other  cases  falling  within  the  purview  of  social 
work)  in  general  fall.  •  We  do  not  intend  to  rehearse  at  this 
point  the  main  features  of  these  cases,  reserving  such  general 
considerations  to  the  main  summary  at  the  end  of  this  book. 
Briefly  taken,  however,  our  considerations  descended  in  com- 
plexity from  (a)  the  immigration  case  of  Agnes  Jackson 
through  (b)  three  somewhat  less  complicated  cases  of  Richard 
Sully  (the  boys'  club  organizer),  Jennie  Walton  (with  her 
peculiar  thievery)  and  Henry  Loyal  (the  steamfitter  of  psycho- 
neurotic trend),  a  series  of  three  cases  in  which  but  two  of  the 
major  mental  hygienic  spheres  of  interest  are  illustrated  (Sully, 
public  and  social ;  Walton,  public  and  individual ;  Loyal,  social 
and  individual)  to  (r)  three  cases  of  still  simpler  nature, 
namely, — Nora  Campbell  whose  offense  and  nature  was  such 
as  to  make  her  dominantly  a  public  service  case  with  social  and 
individual  features  overshadowed  by  her  apparent  criminality; 
Alfred  Mack,  an  alcoholic,  without  special  public-service  com- 
plications, with  comparatively  simple  diseases  and  charac- 
teristics to  contend  with  and  whose  handling  was  a  practical 
matter  of  straight  social  work ;  James  Bailey,  the  subject  of  the 
present  sketch. 

How  can  we  justify  placing  James  Bailey  amongst  cases  that 
.are  chiefly  individual  in  their  mental  hygienic  problem?  The 
grounds  of  this  claim  are  that  Bailey's  relation  to  the  public 
service  was  of  the  most  tenuous,  consisting  merely  of  his  rela- 
tions w'ith  the  psychopathic  hospital  out-patient  department, 
that  the  social  work  involved  was  relatively  obvious,  and  that 
all  the  work  involved  led  very  directly  back  to  the  medical  situa- 
tion (injury,  "functional"  lameness  and  gait)  and  his  char- 
acter, somewhat  resentful  of  sympathy. 

The  previous  cases  in  this  present  group  of  seven  have  been 
analyzed  also  briefly  according  to  the  peculiarities  and  special 
aspects  of  the  maladjustments  or  "evils"  which  they  presented. 


THE    KINGDOM    OF    EVILS  45 

The  analysis  of  numerous  cases  upon  this  schema  of  evils  is 
to  be  pursued  in  the  second  part  of  this  book  and  to  be  further 
synthesized  in  our  summary  at  the  end.  In  this  first  part  of 
our  analysis  we  have  discussed  cases  from  the  standpoint  of 
their  falling  into  one  or  other  or  even  into  two  or  perhaps  three 
of  what  may  be  called  the  major  spheres  of  interest  and  of 
authority  in  mental  hygiene.  We  have  in  this  first  part  of  our 
book  discussed  the  practical  status  which  the  personality  of  a 
psychopath,  with  all  its  internal  and  environmental  complica- 
tions, possesses  in  the  existent  human  world,  subdivided  as 
this  world  is  into  interests  maintained  by  (a)  organized  gov- 
ernment (courts,  state  hospital  societies,  etc.),  (b)  community 
interests  of  a  less  organized  character  (voluntary  social  agen- 
cies, and  other  efforts  of  citizens  at  large),  (c)  and  the  interests 
of  the  individual  himself  (as  mainly  controlled  by  physicians 
and  by  other  personal  guides  endeavoring  to  effectuate  such 
changes  inside  of  the  personality  as  may  straighten  out  the 
entire  tangle). 

However,  even  in  these  cases,  presented  from  the  aspect  of 
the  three  main  spheres  of  authority  or  applied  influence  into 
which  they  fall,  we  have  seen  the  main  divisions  of  social  mal- 
adjustment stand  out.  To  take  this  last  case,  James  Bailey, 
for  example,  we  find  him  afflicted  first  with  some  obvious  med- 
ical complaints  requiring  rather  obvious  attention.  But  he  is 
much  more  importantly  afflicted  with  a  special  attitude  to  life, 
a  definite  slight  defect  of  character  requiring  very  particular 
attention  for  its  correction  or  compensation.  Re  educational 
defect,  this  young  Russian  Jew  is  rather  well  informed,  despite 
his  feeling  that  he  is  not  as  well  educated  as  he  should  be.  It 
would  be  a  nice  point  to  determine  whether  we  shall  regard 
Bailey's  educational  question  as  a  matter  of  character  defect 
or  as  a  matter  of  a  true  deficiency  in  knowledge  of  how  a 
young  man  in  his  plight  ought  to  look  upon  his  future.  Of 
course,  in  a  general  way  also,  Bailey  is  (from  the  so-called 
middle-class  standard  in  America)  not  too  well  informed,  and 
this  may  be  regarded  as  an  effect  of  his  origin  in  the  Russia 
of  recent  years  and  his  transplantation  to  the  American  soil 
of  today. 

From  the  moral  point  of  view,  Bailey  is  exemplary;  from 
the  standpoint  of  legal  entanglements  he  has  entangled  himself 


46  THE    KINGDOM    OF    EVILS 

somewhat  in  lawsuit  preparations  over  his  railway  injury.  As 
for  Bailey's  economic  plight,  he  groups  with  the  so-called 
"marginal"  cases  and  would  not  prominently  classify  in  the 
group  of  poverty  and  resourcelessness. 

Hours  spent  by  Medical  record,  7  pages 

Social  record,  21  pages 
Physician,  3  Social  work : 

Visits,    14 
Psychologist,  0  Interviews  at  hospital,  21 

Telephone  calls,  21 
Social  worker,  42  Letters,  21 


BOOK  II 


The  land  of  the  shadozv  of  death, 
without  a}iy  order. 

Job,  Chapter  lo,  Verse  22. 


THE  FIVE  MAJOR  FORMS  OF  EVIL 
IN  THE  REGNUM  MALORUM 

Arranged  for  the  Purposes  of 
General  and  Psychiatric  Social  Work 

Diseases  and  Defects  of  Body  and  Mind         Morbi  (M) 

Cure! 
Educational  Deficiencies  and  Misinformation      Errores  (E) 

Teach ! 
Vices  and  Bad  Habits,   Non-psychopathic         Vitia  (V) 

Train ! 
Legal  Entanglements  In  and  Out  of  Court         Litigia  (L) 

Counsel ! 
Poverty  and  Other  Forms  of  Resourceless-         Penuriae   (P) 
^^ss  Provide! 

ANALYZED    IN 
THIRTY-ONE    SPECIMEN    PSYCHIATRIC    CASES 


Note. — The  order  of  evils  here  adopted  is  proposed  for  the  purposes 
of  orderly  exclusion  in  psychiatric  and  other  branches  of  social  case 
diagnosis.  -      - .  .. 


Intelligent  sex  delinquent.  Difficulties  in  public,  social,  in- 
dividual spheres.  Medical,  educational,  moral,  legal,  economic 
factors:  Morhi,  Err  ores,  Vitia,  Litigia,  Penuriae.  Psychiatric 
point  of  viezv. 

Case.  8.  Rose  Talbot  is  one  of  those  rare  examples 
amongst  women  of  the  very  intelligent  sex  delinquent.  She 
is  an  emotional  and  unstable  girl  with  strong  sex  desire,  now 
twenty-four  years  old,  with  a  record  of  marriage  at  seventeen, 
the  contraction  of  syphilis  from  her  husband  (dead  two  months 
after  marriage),  the  birth  of  a  syphilitic  child  (still  living  and 
apparently  normal  after  elaborate  and  intensive  salvarsan  treat- 
ment), and  a  second  marriage  at  twenty-two  with  a  divorce  a 
year  later,  said  divorce  being  procured  by  her  new  husband,  a 
respectable  man,  on  account  of  her  sex  delinquency. 

The  immediate  medical  problem  was  the  cure  of  the  syphilis 
which  went  forward  as  well  as  usual  (or  perhaps  better  than 
usual  in  psychopathic  cases,  whom  it  may  be  difficult  to  make 
appear  at  due  intervals)  to  a  practical  cure,  but  back  of  the 
problem  of  the  acquired  syphilis  is  the  problem  of  the  patient's 
own  emotions  and  will,  whose  disorder  expresses  itself  from  the 
legal  point  of  view  as  sex  delinquency  and  comes  to  the  clinic 
for  diagnosis.  It  is  worth  eternally  insisting  that  not  every 
sex  delinquent  is  by  the  same  token  necessarily  a  psychopath. 
If  psychiatry  is  likely  some  day  to  prove  that  sexual  and  other 
delinquencies  are  somehow  expressions  of  psychopathy,  never- 
theless psychiatry  has  not,  up  to  date,  proved  that  crime  is 
always  and  necessarily  a  disease.  It  does  help  the  task  of  the 
mental  hygienists  when  overenthusiastic  theorists  make  ex- 
travagant claims  to  the  effect  that  crime  is  always  disease,  and 
criminology,  accordingly,  a  part  of  medical  science.  Perhaps 
more  than  half  of  all  sex  delinquents  that  come  publicly  to  the 
surface  are  in  one  way  or  other  psychopathic  (that  is,  either 
severely  or  mildly  psychotic  or  more  or  less  feeble-minded). 

How  does  it  stand  with  Rose  Talbot?  We  have  mentioned 
her  considerable  intelligence,  which  was  eventually  to  be  proved 
by  her  becoming  an  expert  telegrapher.     The  psychological  ex- 

51 


52  THE    KINGDOM    OF    EVILS 

amination  taught  us  at  once  that  from  the  standpoint  of  avail- 
able tests,  she  was  of  high  intelligence.  This  mental  level,  thus 
scientifically  indicated  by  the  psychologist,  was  at  first  sight 
not  at  all  borne  out  by  her  history  when  she  came  to  the  hos- 
pital. She  then  struck  the  ordinary  eye  as  a  hopelessly  unde- 
pendable,  probably  incorrigible  instance  of  an  oversexed  woman 
with  the  added  complication  of  acquired  syphilis  and  a  syphilitic 
child  also  to  be  cared  for.  As  a  social  problem  of  fitting  into 
some  occupation.  Rose  Talbot  was  difficult.  As  soon  as  she 
was  a  woman  grown  she  had  married ;  she  had  learned  no 
trade;  she  was  of  an  intelligence  rather  superior  to  the  level 
of  the  kind  of  work  which  she  could  readily  procure ;  a  lapse 
into  sex  life  had  been  easy,  and  a  continuation  of  it  was  to 
be  expected.  It  is  a  matter  of  interest  that  social  conferences 
held  over  this  case  left  most  of  the  conferees  in  a  dubious 
frame  of  mind.  Upon  reference  to  medical  experts,  one  could 
only  point  out  the  dangerous  menace  of  the  girl's  syphilis  to 
the  community,  whilst  another  physician,  upon  clinical  data 
alone,  felt  inclined  to  think  that  the  girl  must  be  somehow 
"feeble-minded,"  and  still  another  advised  a  reformatory. 
Rose  was,  in  fact,  for  a  time  maintained  in  a  home  for  way- 
ward girls,  but  had  such  spells  of  violence  here  that  she  could 
not  be  managed. 

The  technique  of  the  social  treatment  of  Rose  Talbot  was 
briefly  as  follows:  The  girl  left  her  husband  one  day  in  191 5 
in  a  temper  (due  to  the  suggestion  that  she  live  with  her 
mother-in-law)  and  tried,  as  a  waitress,  to  support  herself  and 
child.  She  made  application  to  the  charity  authorities  for  the 
support  of  her  child  several  months  later  and  the  child  was 
boarded  out.  She  was  thus  under  the  eye  of  social  workers, 
one  of  whom,  under  a  misapprehension  (as  we  now  see  the 
problem)  had  her  arrested  as  above  noted.  She  was  then  put 
on  probation  and  placed  in  a  home  for  wayward  girls  where 
came  those  spells  of  violence  which  now  began  to  indicate  that 
Rose  Talbot  was  not  to  be  a  simple  case  of  delinquency.  At 
a  special  conference  the  majority  of  social  workers  agreed  that 
her  case  was,  for  the  present  at  least,  a  hopeless  one  and  that 
although  there  were  definite  psychopathic  elements,  the  only 
available  policy  was  to  wait  for  the  "overt  act"  which  would 
eventually  allow  her  commitment  and  internment  in  some  recep- 
tacle for  delinquents.     Meantime,  the  baby  would,  of  coufs^.,. 


THE    KINGDOM    OF    EVILS  53 

become  a  public  charge  and  minor  ward  of  the  state.  It  was 
already  obvious  to  the  social  worker  specializing  in  the  man- 
agement of  psychopathic  cases  that  this  hopeless  point  of  view 
was  logically  not  well  founded.  Not  only  had  there  been  pre- 
vious experience  of  relative,  and  often  absolute,  social  read- 
justment in  cases  of  this  general  group  of  psychopathic  sex 
delinquents,  but  also  there  were  special  features  (considerable 
intelligence  and  well-developed  self-respect  and  good  general 
judgment  in  most  matters  outside  the  sex  sphere)  that  made 
the  social  prognosis  of  Rose  Talbot  not  absolutely  dark. 

Nevertheless,  no  psychiatric  social  policy  was  at  once 
adopted.  Rose  was  still  carried  on  the  books  of  the  probation 
office.  A  job  for  her  as  waitress  in  the  country  was  got,  and 
she  paid  her  child's  board.  She  had  promiscuous  sex  relations 
with  boys  about  the  place.  (With  unwarranted  hope  for  sex 
hygiene  and  with  a  technique  not  advocated  by  social  workers, 
an  internist  who  had  known  the  girl  wrote  a  letter  to  the  public 
health  authorities  of  the  town  where  she  was ;  rather  naturally 
nothing  came  of  this  letter.)  Social  workers,  without  psychiat- 
ric training  or  point  of  view,  had  previously  made  an  endeavor 
to  have  the  girl  arrested  as  a  prostitute. 

However,  it  happened  that  Rose  had  already  become  friendly 
with  a  psychiatric  social  worker  and  had  become  well  disposed 
to  the  Psychopathic  Hospital  on  account  of  the  unexpectedly 
gracious  way  in  which  she  had  been  met  by  the  physicians.  In 
friendly,  unofficial  correspondence,  Rose  would  write  such 
sentiments  as  the  following: — 

July  24,  1916 

"But  perhaps  I'd  better  tell  you  my  honest,  way-down-deep 
reason  for  writing.  You  did  seem  to  understand  me  so  well 
while  I  was  there.  Now  please,  Miss  Carroll,  I  am  trusting  you 
so  thoroughly.  Please  don't  tell.  Oh,  I  know  I  shouldn't  write 
or  tell  anyone,  but  it  does  so  prey  on  my  mind.  I'm  trying  so 
hard  to  be  good.  Course  it's  lots  easier  than  at  first,  but  I  want 
so  much  to  be  bad.  I  actually  get  sick  fighting  temptation. 
Why  it's  almost  like  a  curse  or  horrible  misfortune.  I'm  afraid 
I  didn't  inherit  a  very  good  supply  of  will-power.  One  thing  I 
am  learning  good  is  to  control  my  tongue.  And  that's  what 
puzzles  me.  Now,  my  tongue  is  learning  to  behave  quite 
nicely,  but  my  passions  are  the  most  unruly  I  ever  encountered. 
And  it  is  by  the  most  tremendous  effort  that  I  keep  good.     But 


54  THE    KINGDOM    OF    EVILS 

then  I  can  be  thankful  that  there's  a  Httle  improvement.  My  first 
month  at  Trinity  House  was  a  veritable  night-mare.  A  most 
hideous  month.  And  I  know  if  I  give  in  now  I  shall  have  the 
fight  to  do  all  over  again,  or  else  continue  to  be  bad,  and  with 
no  helping  hand  near,  it  is  impossible  to  be  good,  once  I  start 
bad.  But  then,  I  shan't,  because  I  vowed  to  God  that  I  never 
would.  He  will  keep  me  good,  won't  He  ?  Do  answer  soon  cause 
I'm  so  tempted.  And  it's  impossible  to  leave.  I'm  most 
stranded  and  Betty's  board  one  month  in  arrears.  Do  think 
over  the  possibilities  of  my  becoming  a  nurse  and  advise,  your 
sorely  tempted,  trusting  friend." 

July  28,  191 6 

.  .  .  "But  I  will  be  good,  for  if  I  give  in  I  might  just  as 
well  throw  up  my  hands.  And  besides,  God  would  punish  me 
if  I  broke  my  oath,  wouldn't  He?  When  I  was  in  my  cell  at 
James  Street,  waiting  for  trial,  I  swore  to  God  never  to  commit 
adultery  or  fornication  again.  I  couldn't  break  that,  could  I  ? 
Yet  if  He  wishes  me  to  be  good  why,  oh  why,  will  he  allow  me 
to  have  such  horrible  unruly  passions.  And  after  all  my 
prayers !  I  want  so  very  much  to  be  bad.  At  times  I  ache  all 
over,  I  feel  if  I  only  could  be  bad  just  once,  awfully  bad,  I'd  be 
quite  happy  and  satisfied.  He's  a  student.  Treats  me  with  an 
almost  brotherly  affection.  It  is  such  a  relief  to  be  able  to  tell 
you  everything.  .  .  .  And  I'd  give  in  so  quickly  only  I  do  want 
to  be  good,  and  am  scared  too.  I  was  so  much  happier  before 
in  my  ignorance  than  I  am  now  with  my  eyes  open.  I  do  feel 
so  sick  and  miserable  all  the  time." 

August  3,  1916 

"Mrs.  W.  is  going  to  send  me  a  couple  of  pictures  of  Betty. 
I  can  hardly  wait  for  them.  I  shall  be  so  glad  when  I  am  home 
with  her  again.  I'm  just  crazy  about  the  little  kiddo.  I  just 
love  to  work  for  her  now.  At  one  time  I  was  feeling  kind  of 
provoked  to  think  I  could  never  spend  much  for  clothes,  but 
since  I  came  so  near  losing  her,  and  after  being  confined  at 
Trinity  House,  it's  just  wonderful  to  be  free  and  working  for 
her.  I'm  being  so  awfully  good,  not  even  thinking  bad.  You 
see,  it  is  just  once  in  a  while  I  have  those  spells,  and  they  seem 
so  terrible  at  the  time  they  frighten  me,  but  now,  looking  back, 
it  was  nothing  and  confiding  in  you  has  helped  so  very  much. 
I  am  so  glad  I  have  you  for  a  friend  and  true  confidant.  It  is 
just  like  a  headache  (a  thing  I  rarely  have)  but  when  I  do  ! 
think  I'm  killed.  But  there,  I've  troubled  you  long  enough 
with  'I.'  " 


THE    KINGDOM    OF    EVILS  55 

August  28,  19 16 

"I've  read  Casqueline's  (I  think  it  is  spelled)  Truth  about 
Woman  and  Havelock  Ellis'  Psychology  of  Sex  which  quite 
knocked  all  my  good  resolutions  to  smash.  You  see  it  was 
really  the  religious  side  of  me  that  was  keeping  me  good,  and 
my  fear  of  God.  But  Casqueline  states  that  religion  has  nothing 
to  do  with  a  woman  being  bad. — So  you  see  it  is  not  wicked  to 
have  sexual  intercourse  with  other  men  than  your  husband.  It 
is  merely  not  the  fashion. 

"Now  with  you  saying  to  be  good  and  this  book  to  give 
free  rein  to  any  and  all  impulses  and  passion,  what  is  one  to  do  ? 
Especially  when  there  is  so  much  bad  in  them,  and  if  I  was  bad 
it  would  be  to  satisfy  my  own  natural  cravings.  And  I  feel  so 
much  more  fit,  mentally  and  physically. 

"But,  my  gracious,  please  don't  tell  Miss  Ford,  that  I've  been 
talking  in  this  strain  or  they'll  become  alarmed,  which  is  quite 
unnecessary  since  I've  no  intention  of  being  bad  yet. 

"Grandma  says  she'll  be  very  glad  to  see  me  and  I'm  going 
to  live  with  her  and  Betty." 

September  24,  191 6 

"Sometimes  I'm  almost  tempted  to  marry  him.  Oh,  dear,  I 
do  hope  I  keep  a  level  head  and  not  do  any  more  foolish  stunts. 
And  besides  I  simply  cannot  marry.  Anyhow,  I  merely  like 
him  and  am  by  no  means  fond  of  him.  Now,  aren't  you  pleased 
to  hear  I'm  not  going  to  be  bad,  I  mean,  give  in  to  sexual 
desire?" 

November  6,  1916 

"Now,  Miss  Carroll,  this  is  an  honest  fact,  that  just  as  soon 
as  I  start  my  prayers  at  night  and  feel  spiritually  good,  some- 
thing always  turns  up  to  make  me  doubly  bad.  Last  evening  I 
felt  awfully  good  and  said  my  prayers  with  the  baby  and  felt 
that  I'd  never  be  bad  again,  and  behold,  this  morning,  I  awoke 
worse  than  ever." 

January  5,  191 7    ^ 

"I  really  don't  think  I'll  be  bad,  maybe  once  in  a  great,  great 
while,  but  not  in  the  promiscuous  manner  I  have  been.  I  just 
wish  I  could  explain.  I  don't  think  I  can,  yet  you're  the  only 
one  to  whom  I  could  begin  to  explain.  It  is  all  on  account  of 
working  in  the  rubber  shop  and  wearing  that  peachy  dress  you 
gave  me.  Don't  think  that  I'm  all  fussed  up  over  myself,  but 
just  the  same,  I  am  nicer  than  any  worker  in  my  department, 
or  in  fact,  that  I've  seen  here. 


56  THE    KINGDOM    OF    EVILS 

"My  thoughts  run  ahead  of  my  pen.  Of  course  I  couldn't 
make  it  clear  anyhow  because  it's  not  quite  clear  to  me.  I've  a 
great  conceited  bump  on  myself.  Just  a  wee  bit  too  nice  to  be 
bad.  I've  thought  of  it  a  good  deal  and  seems  to  me  I've  had 
symptoms  a  way  back,  but  lately  they  are  becoming  no  end 
developed !" 

March  17,  191 7 

"We  have  broken  partnership,  it  really  was  that  you  know. 
There  we  were,  two  perfectly  mated,  physically  and  mentally — 
human  beings,  each  desiring  one  of  the  opposite  sex  without  the 
binding  and  restraining  tie  of  marriage.  It  really  is  too  bad. 
He  was  awfully  decent  and  I  liked  him  thoroughly,  in  fact  could 
almost  say  it  was  a  good  like.  And  again  I  say  it  is  too  con- 
founded mean  that  one  can't  have  free  love,  or  at  least  until 
the  children  come.  But  there,  I  shall  have  to  see  you  to  tell  you 
all  about  it." 

July  4,  1917 

"Am  going  to  dress  Miss  Betty  up  and  take  her  for  a  visit. 
Oh,  I  do  love  her  so  much,  so  very  much,  that  I  have  no  room 
for  any  one  else,  which  is  rather  good,  considering  I  have  been 
thru  so  many  'puppy  loves' !" 

October  14,  191 7 

"Yes  I  do  (i.e.  love  her  divorced  husband)  and  suppose  I 
always  will.  Time  hasn't  done  much  healing  in  my  case,  but  I 
do  think  that  God  has  given  me  a  pretty  poor  hand,  perhaps  in 
the  next  deal  it  may  be  filled  with  brightness  and  I  shall  live  and 
enjoy  a  happy  old  age,  that  is,  if  I  do  live.  I  strongly  contem- 
plate suicide  in  every  moody  spell,  and  I  feel  quite  justified  for 
does  not  our  Lord  say  'Come  ye  who  are  weary  and  heavy-laden 
and  I  will  give  ye  rest.'  So  why  not  accept  such  a  wonderful 
invitation.     Still  I  rather  think  I  am  too  much  of  a  coward." 

There  seems  to  be  no  reason  why  the  sentiments  of  these 
letters  should  not  be  taken  on  their  face  value.  When  Rose 
was  dropped  from  the  books  of  the  Probation  Office,  she  felt 
that  she  still  required  counsel  and  voluntarily  applied  to  the 
Psychopathic  Hospital  for  supervision.  During  a  period  of 
two  years  that  she  has  since  been  under  the  hospital's  official 
care  her  life  and  aims  have  pursued  a  gradual  up-gradient. 
She  became  aware  that  her  intelligence  was  superior  to  that 
of  her  fellow  mill  workers  (she  had  betaken  herself  to  work 


THE    KINGDOM    OF    EVILS  57 

In  a  rubber  factory,  somewhat  against  her  wish  for  less  con- 
fining work)  and  herself  got  the  idea  of  going  into  telegraphy. 
She  is  now,  at  the  end  of  these  two  years,  getting  seventy-five 
dollars  per  month,  is  paying  for  the  maintenance  of  her  child 
in  the  (paternal)  great-grandmother's  home,  and  is  living  a 
much  more  promising  and  orderly  life  than  anyone  could  have 
predicted.  A  peculiarity  of  the  situation  is  that  she  is  now 
living  with  her  divorced  husband  once  more.  The  question 
of  marriage  has  indeed  been  raised,  but  it  is  the  girl,  rather 
than  her  former  husband,  who  remains  in  doubt  of  the  wisdom 
of  the  procedure.  To  be  sure,  her  syphilis  is  as  well  in  hand 
as  can  be  contrived;  at  all  events,  her  blood  serum  test  has 
now  remained  normal  for  some  time. 

Let  us  now  analyze  the  Talbot  case  in  two  ways.  First  let 
us  analyze  it  briefly,  after  the  manner  of  the  first  part  of  this 
book,  namely,  as  to  the  existence  of  public,  social,  and  indi- 
vidual factors  in  the  case,  and  their  relative  importance.  We 
may  then  follow  the  analysis,  according  to  spheres  of  com- 
munity influence,  with  a  further  analysis  according  to  the  dis- 
tribution of  the  various  evils  shown  by  the  case,  thus  intro- 
ducing the  topic  of  Book  II.  It  goes  almost  without  saying 
that  a  case  as  complicated  as  that  of  Rose  Talbot  must  have 
planes  of  contact  of  both  a  public  and  a  private  nature.  We 
may  count  as  of  a  public  nature,  for  example,  her  arrest  for 
adultery,  socially  ill  advised  as  that  arrest  may  have  been.  As 
of  a  social  (non-public  nature)  we  must  count  her  promiscuity 
in  sex  relations  and  her  quarrelsomeness  with  her  spouse.  The 
divorce  complications  touch  both  governmental  authorities  on 
the  one  hand  and  the  more  private  social  relations  on  the  other. 
As  the  history  of  the  case  shows,  very  possibly  the  sex  promis- 
cuity and  even  the  girl's  quarrelsomeness,  socially  difficult  prob- 
lems though  they  are,  may  well  be  regarded  as  fundamentally 
of  a  medical  nature.  If  hypersexuality  and  irritability  are  not 
regarded  in  the  lay  mind  as  necessarily  examples  either  of 
mental  disease  or  of  mental  defect,  nevertheless,  from  the 
psychiatric  standpoint  and  from  the  standpoint  of  the  psychiat- 
ric social  worker,  these  tendencies  are  coming  more  and  more 
to  be  regarded  as  essentially  psychopathic.  Even  if  we,  in  the 
end,  come  to  regard  them  as  eccentricity  rather  than  psychop- 
athy, nevertheless  cases  of  sex  appetite  and  cases  of  anger 
instinct  can  best  be  understood  in  psychopathic  terms.     The 


58  THE    KINGDOM    OF    EVILS 

public  and  private  factors  of  this  case,  or  (to  use  our  preferred 
tri-partition  of  factors)  the  pubhc,  social,  and  individual  factors 
of  ihis  case  are  not  only  all  well  represented  but  are  commingled 
in  such  wise  that  it  is  extremely  difficult  to  "factor"  them  out, 
as  they  say  in  books  of  arithmetic.  The  factors  unite  in  a 
complex  unit  which  is  not  the  result  of  summation  as  much  as 
of  multiplication. 

Without  delaying  upon  the  further  analysis  of  the  Talbot 
case  from  the  standpoint  of  community  influences  (see,  for 
examples  of  such  analyses,  cases  of  Book  I,  e.g.,  case  4)  let 
us  consider  her  from  the  standpoint  of  the  evils.  This  is  not 
the  place  to  descant  either  upon  the  completeness  of  our  list  of 
evils  or  upon  its  exactitude.  The  appraisal  of  this  manner  of 
analysis  may  be  postponed,  nor  shall  we  be  prepared  to  discuss 
it  fully  until  the  medical  data  of  Book  III  are  well  in  mind. 
As  briefly  in  Book  I,  we  proceed  to  a  study  of  the  medical, 
educational,  moral,  legal,  and  economic  factors,  under  the  guise 
of  the  evils  of  disease  (Morbi),  ignorance  (Errores)  vices 
and  bad  habits  (Vitia),  crime  and  delinquency  and  other  forms 
of  legal  entanglements  (Litigia),  and  poverty  and  other  forms 
of  resourcelessness  (Penuriae).  The  medical  side  of  Rose 
Talbot  is  evident;  character  defects  and  certain  overemphases 
of  instinct,  to  say  nothing  of  syphilis.  The  educational  de- 
ficiency in  Rose  Talbot  is  most  obvious  and  stands  out  the 
more  clearly  because  she  was  by  no  means  feeble-minded  and, 
in  fact,  responded  notably  well  to  the  instructions  given  her, 
at  first  by  the  psychiatrist  and  later  by  the  psychiatric  social 
worker.  It  was  clear,  too,  that  in  addition  to  an  educational 
deficiency  (both  in  the  matter  of  school  life  and  home  instruc- 
tion) there  was  a  pronounced  moral  deficiency  It  is  not  in- 
cumbent on  us  to  determine  here  (or  perhaps  anywhere  in  this 
book)  whether  there  is  a  distinction  between  intellectual  and 
moral  education,  and  no  doubt  many  of  the  moral  deficiencies, 
so  obvious  in  these  cases,  are  not  only  grounded  in  lack  of  in- 
formation or  in  misinformation,  but  can  be  abolished,  almost 
at  a  blow,  by  suitable  teaching  of  a  very  ex-cathedra  type.  But 
Rose's  moral  deficiencies  were  in  spheres  of  emotion,  which 
mere  instruction  out-of-hand  could  not  relieve.  In  point  of 
fact  a  good  deal  of  her  difficulty  may  be  assigned  to  disease 
and  not  to  mere  inadequacy  of  moral  training.  It  will  be  re- 
membered that  there  was  much  to  go  upon.     There  was  the 


THE    KINGDOM    OF    EVILS  59 

girl's  rather  lively  self-respect  in  all  matters  save  those  of  sex; 
and  even  in  the  sex  sphere  there  was  finally  developed  the 
monogamous  trend.  The  rather  extraordinary  improvement  in 
what  one  might  term  the  individual  "morale"  of  Rose  Talbot 
when  a  certain  blue  serge  dress  was  given  her  (see  letter  in 
text)  cannot  readily  be  ascribed  to  education  of  the  intellectual 
sort.  That  singularly  successful  step  on  the  part  of  the  psy- 
chiatric social  worker  was  an  ethical,  rather  than  a  psycho- 
logical, step. 

It  is  clear  that  in  trying  to  distinguish  between  the  medical, 
intellectual,  and  moral  deficiencies  in  a  case  like  this  we  ap- 
proach fundamentals  in  the  definition  of  medicine,  education, 
and  ethics,  definitions  which  are  not  always  easy  to  get  in  text- 
books of  these  disciplines.  When  we  approach  the  fourth 
group,  delinquencies,  we  naturally  find  the  plot  to  thicken 
appreciably,  as  we  have,  indeed,  the  choice  of  regarding  the 
delinquencies  of  Rose  as,  on  one  hand,  purely  medical  in  origin, 
and  therefore  not  delinquencies,  or  on  the  other  hand  as  due 
purely  to  faulty  education  (and  therefore  hardly  matters  for 
which  she  could  be  called  to  serious  account),  or  even  as  mat- 
ters of  poor  moral  training  (wherein  again,  the  handling  of 
the  case  as  criminal  or  legal  would  not  serve  the  turn).  But 
in  what  consists  the  delinquency  or  legal  entanglement  in  this 
broad  sense  ?  We  are  using  the  idea  in  a  purely  practical  way. 
We  shall  find  it  desirable  to  analyze  each  case  in  succession 
from  all  of  these  standpoints.  For  practical  purposes,  no  one 
can  deny  that  it  is  important  for  the  psychiatrist  and  for  the 
psychiatric  social  worker  to  consider  the  legal  entanglements 
and  the  methods  of  fighting  them  which  are  brought  up 
by  any  case  which  demands  social  consideration  and  social 
management. 

So  again,  when  we  consider  the  economic  disabilities  of  Rose 
Talbot  (with  her  lack  of  knowledge  of  a  trade  at  the  outset, 
her  syphilis  to  be  medically  and  perhaps  expensively  treated, 
and  her  child,  also  syphilitic)  we  need  not  deny  that  another 
lot  in  life  would  have  entirely  altered  the  complications  of  her 
particular  fate,  but  the  fact  that  good  middle-class  surroundings 
would  have  changed  this  particular  fate  does  not  necessarily 
mean  that  economics  is  the  sole,  or  even  the  leading,  feature  in 
the  whole  circumstances.  Accordingly,  we  find  in  Rose  Talbot, 
good  examples  of  what,  upon  common-sense  grounds,  we  must 


6o  THE    KINGDOM    OF    EVILS 

regard  as  deficiencies  in  all  five  fields  of  evil,  as  we  have  chosen 
to  name  them.  The  order  in  which  these  fields  of  evil  have 
been  laid  down  is  also,  we  surmise,  not  more  ultimate  than  the 
fields  of  evil  themselves.  In  fact,  in  social  work  at  large,  it 
has  always  been  thought  that  the  economic  factor  must  take 
a  leading  place.  It  is  our  impression  that  even  in  general  social 
work  (and  many  social  workers  agree  with  us)  the  economic 
factor  is  often,  if  not  in  a  majority  of  cases,  outweighed  by  one 
or  more  other  factors  of  evil  that  we  here  list. 

Perhaps  it  is  worth  while  to  make  one  or  two  further  com- 
ments upon  Rose  Talbot.  Her  improvement  under  social- 
psychiatric  treatment  was  remarkable  enough,  particularly  as 
she  had  been  an  unsolved  problem  zvith  no  less  than  three  agen- 
cies before  she  was  studied  and  treated  from  the  psychiatric 
point  of  view.  It  would  be  less  easy  to  define  exactly  in  what 
the  social-psychiatric  treatment  of  Rose  Talbot  consisted,  and 
perhaps  we  had,  at  this  point,  best  fall  back  on  saying  that  the 
fons  et  origo  of  the  success  lay  just  in  the  "point  of  view."  It 
might  also  be  inquired  how  genuinely  successful  the  treatment 
has  been,  and  no  doubt  the  Greek  warning,  that  we  can  scarcely 
assign  happiness  to  a  life  until  it  is  ended,  is  a  warning  that 
we  should  particularly  heed  in  social  work.  At  the  risk  of 
repetition,  let  us  insist  again  upon  the  extraordinary  contrast 
between  the  girl's  genuine  self-respect  and  her  amoralia,  or 
what  the  old  English  psychiatrist  Pritchard  might  have  termed 
"moral  insanity." 

It  is  of  subordinate  nature,  perhaps,  that  during  the  years 
of  psychiatric  social  treatment,  Rose  has  been  under  the  per- 
sonal charge  of  four  social  workers  in  succession  and  has, 
nevertheless,  responded  properly  to  all  four,  despite  their  own 
differences  in  personality.  This  brings  out  strongly  the  point 
we  above  made,  namely,  that  the  success  in  treatment  depends 
more  upon  the  point  of  vieiv  than  upon  the  personality  of 
the  worker.  We  know  that  such  a  statement  as  that  in  the 
previous  sentence  may  well  be  regarded  as  revolutionary  by 
some  authorities  who  very  particularly  point  out  the  great  im- 
portance of  the  personal  relation,  the  relation  of  being  en 
rapport  in  these  subtle  forms  of  psychotherapy.  (Of  course 
another  way  of  controverting  this  revolutionary  point  of  view 
of  ours  would  be  to  say  that  all  four  of  our  workers  were,  as 
it  were,  of  a  superior  quality!     This  the  psychiatrist  might 


THE    KINGDOM    OF    EVILS  6l 

be  compelled  to  concede.  Yet  it  is  true  that  persons  of  a  very 
special  nature  are  just  the  persons  that  remain  in  psychiatric 
social  work,  at  least  in  its  responsible  phases.)  It  is  not  so 
much  the  point  of  view  of  the  worker  as  it  is  difficulties  in 
effecting  the  new  contacts  entailed  by  the  shifting.  This  at 
least  is  our  general  experience,  into  which  we  cannot  here 
farther  go.  In  point  of  fact,  it  would  be  singularly  unlucky 
if  the  only  personal  relation  which  the  psychiatric  patient  could 
successfully  maintain  with  social  work  should  be  a  relation  with 
but  one  human  soul,  since,  in  the  nature  of  things,  in  the  course 
of  years  (and  these  cases  are  year-long  in  their  symptoms  and 
demand  for  treatment)  there  must  be  effected  a  number  of  such 
transfers  of  control. 

Another  subordinate  point  in  the  technique  of  social  work 
in  the  case  of  Rose  Talbot,  is  the  singularly  small  part  which, 
in  appearance  at  least,  the  psychiatrist  plays  in  the  details  of 
treatment,  in  fact,  the  general  course  of  social  treatment  is  not, 
in  this  case,  one  specially  conducted  by  the  psychiatrist;  it  was 
rather,  the  duty  of  the  psychiatric  social  worker,  on  the  basis 
of  the  medical  diagnosis,  to  proceed  to  establish  proper  general 
lines  of  treatment.  It  is  entirely  doubtful  in  our  minds  whether 
a  physician,  either  male  or  female,  could  have  gotten  into  the 
right  relations  with  Rose  Talbot. 

Hours  spent  by  Medical  record,  23  pages 

Social  record,  49  pages 
Physician,  4  Social  work  : 

Visits.   37 
Psychologist,   l  Interviews  at  hospital,  1 1 

Telephone  calls,  14 
Social  worker,  102  Letters,  a8 


FEEBLE-MINDED  YOUTH 

24  YEARS 
(BY  MENTAL  TESTS  9.3) 


191 5 
Unemployment 
Homelessness 
No  Income 

Estrangement  from  Relatives 
Recidivism  (Larceny) 
Arrest  (Arson) 
Probation 


ig)i6 
Employed 
Good  Home 
Good  Wages 
Reconciled  to  Relatives 

Stealing 
Disappeared 


1917 
U.  S.  Marine 


Feeble-fninded  recidivist  who  set  a  fire.  On  probation  ran 
away.     Later  corporal  of  marines. 

Case  g.  Thomas  Fuller's  real  name  was  Michael  Kelly. 
Thomas  was  a  reformatory  boy  and  after  he  left  the  reforma- 
tory chose  to  avoid  its  stigma  by  assuming  his  mother's  name. 
He  was  twenty-four  when  we  first  came  into  contact  with  him 
after  his  arrest  for  "maliciously  burning  a  dwelling-house." 
We  present  him  as  a  paradigm  of  evils,  not  quite  so  progressive 
as  his  predecessor  in  this  series,  Rose  Talbot,  for  Thomas 
Fuller,  despite  the  fact  that  he  measured  less  than  ten  years 
by  the  psychometric  tests,  got  on  well  enough  in  the  econornic 
sphere.  He  showed  signs,  however,  of  trouble  in  each  of  the 
other  four  fields,  medical,  educational,  moral,  and  legal. 

To  be  sure,  there  was  no  obvious  sign  of  disease  in  Thomas. 
He  looked  younger  than  his  years,  but  was  of  a  stocky  and 
well  set-up  build,  as  indeed,  the  United  States  government  was 
eventually  to  find  and  to  exult  in.  But  from  our  chosen  point 
of  view,  we  must  regard  his  low  mental  age  as  a  medical 
disability. 

Thomas  Fuller's  father  had  long  since  disappeared,  leaving, 
at  the  time  of  our  first  observation  of  Thomas,  three  sisters  in 
the  late  teens.  The  mother,  who  had  cared  for  the  children 
until  Thomas  was  fifteen,  had  died  in  an  almshouse;  the 
younger  children  had  been  left  in  an  orphan  asylum  by  the 
father,  who  then  vanished  from  the  scene.  Thomas  got  no 
schooling  until  his  twelfth  year,  with  a  little  further  schooling 
at  the  age  of  fourteen,  and  with  three  years  of  reformatory 
life  in  the  late  teens.  The  boy's  moral  training  had  suffered 
throughout  such  a  life.  The  marvel  is  that  his  moral  adequacy 
could,  in  the  long  run,  be  maintained.  His  arrest  for  "will- 
fully and  maliciously  burning  a  dwelling-house"  was  but  a 
single  episode,  and  unlike  phenomena  in  some  of  our  psycho- 
paths, could  not  be  regarded  as  in  any  case  a  perversion  of 
instinct  such  as  may  be  found  in  pure  pyromania. 

65 


66  THE    KINGDOM    OF    EVILS 

Fuller,  one  day,  in  a  fit  of  despondency,  set  fire  to  his  por- 
ter's uniform  which  lay  on  the  bureau  in  his  room.  He  had 
been  discharged  from  his  porter's  job  and  apparently  decided 
to  let  that  whole  part  of  his  life  go  up  in  smoke.  The  under- 
standing how  this  might  be  both  the  first  and  the  last  episode 
of  this  identical  nature  (as  against  the  story  of  so  many  pyro- 
maniacs  who  keep  on  kindling  fire  after  fire,  apparently  for  the 
gratification  of  a  particular  instinct)  is  made  a  bit  easier  by  a 
study  of  sundry  facts  in  Thomas's  past  life.  Without  going 
into  these  in  detail,  we  may  mention  that  he  had  at  times  stolen 
money  and  again  clothing,  and  had  even  participated  in  a  small 
"break"  into  a  house  with  companions.  He  was,  in  short,  a 
sort  of  youthful  recidivist  in  a  variety  of  not  extremely  serious 
crimes.  It  was  as  if  a  feeble-minded  boy,  not  educated  even 
up  to  his  mental  capacity,  and  with  poor  and  fragmentary  moral 
training,  had  become  a  delinquent  despite  himself. 

In  point  of  fact,  the  case,  from  the  legal  standpoint,  was 
quickly  resolved  by  the  psychometric  observations — Point 
Scale  9.3  years,  Binet  9.2  years.  His  deficiency  of  mind  was 
of  what  may  be  termed  the  truncated  variety.  The  defect  wa'^ 
an  even  and  regular  one,  not  affecting  the  years  above  the  grade 
registered.  Whatever  intellectual  and  moral  education  could 
be  given  to  Thomas  Fuller  must  reckon  with  this  fundamental 
mind  lack.  There  could  hardly  be  a  stronger  contrast  than  that 
between  the  cases  of  Rose  Talbot  and  Thomas  Fuller.  The 
one  was  an  intelligent  woman,  with  much  to  build  upon,  both 
intellectually  and  morally,  despite  her  hypersexuality  and  tan- 
trums; the  other  was  a  moron  boy,  with  no  special  sex  pro- 
clivities. Both  enjoyed,  however,  good  physique,  and  both 
proved  singularly  accessible  to  social  work. 

Probably,  in  a  large  part  because  of  his  exemplary  sex  record, 
the  judge  who  dealt  with  the  charge  of  "burning  a  dwelling- 
house"  did  not  even  commit  Fuller  on  the  hospital  determina- 
tion of  his  feeble-mindedness,  but  on  probabilities  (or  perhaps 
as  a  matter  of  speculation)  he  was  put  on  probation  and  proved 
a  ready  subject  of  social  work  and  remained  a  faithful  super- 
visee for  the  six  months  that  he  was  on  probation.  He  was 
somewhat  disheartened  by  the  extension  of  his  probationary 
period  for  a  further  six  months,  and  a  month  after  the  exten- 
sion was  granted  he  disappeared  from  view  after  a  charge 
(correct  or  false)  that  he  had  again  stolen  clothing.     Letters 


THE    KINGDOM    OF    EVILS  dj 

from  no  address  not  infrequently  appeared  at  the  hospital 
assuring  the  workers  of  his  continued  success  in  life. 

The  denouement  was  now  to  be  altered  by  the  World  War. 
He  enlisted  in  the  marines  and  he  wrote  that  he  was  now  "some 
man" ;  that  he  was  "satisfied  and  at  peace  with  the  world"  and 
that  he  would  "never  forget  his  friends  at  the  hospital." 

We  have  a  number  of  Thomas's  letters,  written  in  a  large 
round  hand.  Almost  always  he  begins  "I  write  you  a  few 
lines  'hopping'  to  find  you  well  as  I  am."  Some  extracts  from 
letters  with  the  war  fervor  are  as  follows : — 

September  14,  191 7 

"My  Dear  Friend:  I  write  you  a  very  few  lines.  I  hope 
to  find  you  well,  as  I  am.  And  that  you  will  time  to  read  the 
letter,  or  when  you  read  it  you  may  call  it  a  book.  I  know  that 
you  like  to  read  books  so  that  all  right.  Well  I  like  to  write  to 
friend's,  So  you  are  one  that  I  could  not  forget.  The  old  saying 
it  a  treasure  to  have  friends.  Well  you  would  like  to  know  all 
about  me.  Well  hear  gos.  In  the  frist  plase,  I  have  maked 
good  without  no  one  help.  It  noting  like  trying  to  make  good 
that  me.  I  thought  I  like  to  be  a  marine,  so  I  went  in  the 
U.  S.  Marine  Corps,  for  luck.  And  I  have  luck  all  the  way,  so 
good.  And  I  am  going  to  tell  you  that  I  am  now  out  off  the 
past,  and  I  don't  mind  tell  you,  that  I  am  now  "some  man,"  And 
I  feel  like  a  man  who  has  eaten  a  real  dinner,  very  much  satis- 
fied and  at  peace  with  the  world.  What  do  you  think  off  that. 
And  let  me  tell  you  my  friend,  that  I  have  not  forgotten  your 
kind  advice  yet.  It  is  very  indeed  profitable  to  me.  And 
started  out  to  make  good,  I  did  you  know.  Well  the  last  time 
that  seen  you,  I  have  traveled  over  this  world  a  bit,  I  rought  it 
to  france.  Washington  D.  C.  and  I  seen  the  best  man  that  the 
big  world  of  our  love  him,  tell  me  the  one  that  I  mean  see  if  you 
know  the  one  man  I  mean.  I  love  him  with  all  my  heard.  And 
I  don't  mind  tell  you  that  I  am  now  a  man  with  some  good 
experience.  And  I  have  live  a  pretty  hard  life.  And  I've  been 
down  pretty  low,  and  now  I  am  up,  and  that  is  what  counts. 
And  I  have  won  out,  I  am  going  to  forget  the  methods  I  used 
in  the  past  life.  I  am  going  to  make  everybody  else  forget 
them.  I  want  to  enjoy  the  remainder  of  my  earthly  existence. 
"Well  Dear  friend  I  will  come  to  a  close  with  this  letter 
very.  I  am  now  in  the  U.  S.  Marine.  And  I  am  not  Thomas 
Fuller,  but  I  am  the  Private  Michael  Kelly.  I  would  like  very 
much  to  hear  from  a  good  friend  like  you  Miss  Carroll.  And 
the  25th  of  Dec.  1917  you  get  sum  thing  from  me,  and  if  I  go 


68  THE    KINGDOM    OF    EVILS 

to  war,  you  will  have  sum  thing  remmber  by.  Write  and  tell 
me  how  you  are,  and  how  very  one.  On  my  27th  birthday 
not  one  send  me  a  brithday  card.  As  I  have  no  more  to  say 
this  time  I  will  come  to  a  close. 

"And  to  you  My  sincere  appreciation  to  you  and  the  good 
worker  at  the  hospital. 

"Wishing  you  all  success." 

September  21,  191 7 

"Well  my  Dear  friend.  I  take  the  greates  in  writing  to  you 
these  few  lines  to  you  dear  friend.  And  was  very  glad  to  hear 
from  you  too.  It  was  your  postcard  that  you  send  to  me,  it  is 
the  boston  state  house,  some  place  you  know.  And  the  State 
House  looks  very  good  to  me,  you  bet.  And  I  know  that  you 
wrote  that  card.  I  remember  your  good  hand  off  writing,  that 
you  write,  write  again  plase.  Well  dear  friend  I  do  not  very 
well  when  I  will  be  send  to  france  but  I  may  go  any  time  to 
france  to  fight  for  freedom,  and  peace.  And  let  me  tell  you 
that  I  will  fight  in  earnest  for  our  be  love  and  dear  presidend 
Wilson,  the  man  off  the  hour.     I  like  him  with  all  my  heart. 

"And  I  will  not  forget  my  friends.  I  will  think  off  them 
when  I  am  over  in  france.  and  now  I  will  not  forget  you  as 
you  are  one  off  my  friends.  You  said  that  they  are  knitting 
at  the  hospital  for  the  soldiers.  And  you  asked  me  if  I  could 
used  and  thing.  Well  I  can  used  and  thing  that  you  send.  I 
would  be  glad  to  get  anything  that  you  send  to  me.  Will  close 
hopping  to  hear  from  you." 

March  29,  19 18 

"I  write  you  a  few  lines  hopping  to  find  you  well  as  I  am. 
Well  I  have  make  good,  as  I  am  now  an  corporal  in  the  U.  S. 
Marine  Corp.  that  mean  that  I  am  to  get  $6.  more  an  month. 
So  I  am  now  getting  $36.  an  month  now.  Well  I  am  doing 
the  best  I  know  how,  that  whi  I  was  make  an  corporal  in 
corps.  I  hope  that  you  will  write  me  an  letter  and  tell  me  how 
you  like  the  way  I  am  making  good." 

Hours  spent  by  Medical  record,  25  pages 

Social  record,  34  pages 
Physician,  4'  Social  work: 

Visits,  18 
Psychologist,  i  Interviews  at  hospital,  23 

Telephone  calls,  40 
Social  worker,  50  Letters,  45 


THE    KINGDOM    OF    EVILS  69 


Hysterical  sex  delinquent,  a  persistent  social  problem. 

Case  10.  Bertha  Greenwood  is  a  case  which  we  present 
as  a  paradigm  of  troubles  in  the  medical,  educational,  moral, 
and  economic  fields.  She  is  the  second  of  a  group  of  five  cases 
in  which  the  troubles  are  fourfold.  Bertha  Greenwood's  case 
is  less  complex  by  one  field  of  evil,  according  to  our  proposed 
classification,  than  was  Rose  Talbot  (case  8)  whose  troubles 
were  fivefold..  Theoretically  we  should  be  able  to  subtract  from 
the  difficulties  of  Rose  Talbot  the  legal  entanglements  and 
arrive  at  the  case  of  Bertha  Greenwood ;  so  theoretically  ought 
we  to  have  been  able  to  subtract  the  social  difficulties  of  eco- 
nomic nature  from  the  case  of  Rose  Talbot  and  arrive  at  some- 
thing like  the  degree  of  complication  found  in  Thomas  Fuller 
(case  9).  Taken  another  way,  the  phenomena  of  Bertha 
Greenwood  will  have,  in  common  with  those  of  Thomas  Fuller, 
three  kinds  of  factor,  and  will  differ  in  but  one  factor :  both 
cases  are  fourfold  with  respect  to  their  distribution  of  troubles; 
both  have  difficulties  in  the  medical,  educational,  and  moral 
fields,  but  whereas  Fuller's  difficulties  were  legal.  Bertha 
Greenwood's  difficulties  were  economic. 

Bertha  Greenwood,  we  must  confess,  for  the  present,  after 
three  years  of  social  observation  and  attempted  treatment,  to 
be  a  good  deal  of  a  failure  from  the  standpoint  of  psychiatric 
social  work,  but  it  is  no  province  of  this  book  to  put  necessarily 
the  best  foot  foremost.  Perhaps  it  is  better  to  deal  with  the 
grounds  of  failure  in  sundry  cases  than  to  congratulate  our- 
selves unduly  over  the  most  striking  success. 

The  reasons  for  the  failure  of  our  social  methods  in  Bertha 
Greenwood  are  obscure,  but  probably  based  upon  our  lack  of 
grasp  upon  her  attitude.  That  attitude  is,  no  doubt,  a  psycho- 
pathic one.  Her  temperament  is  one  of  ups  and  downs  that 
are  apt  to  occur  in  waves  of  considerable  length  as  well  as 
amplitude.  The  term  "psychopathic  personality"  which  is,  in 
general,  a  proper  designation  for  this,  as  for  many  other  cases, 
does  not  duly  specify  the  peculiar  difficulties,  which  are,  per- 
haps, a  compound  of  hysterical  tendencies,  with  a  cyclothymic 
(manic-depressive)  tendency,  expressing  itself  rather  more  in 
periods  of  depression,  of  weeks'  or  months'  standing,  than  in 
any  periods  of  pronounced  elation. 


70  THE    KINGDOM    OF    EVILS 

In  her  periods  of  comparative  normality,  Bertha  is  extremely 
manageable,  and  amenable  in  some  degree  to  suggestion,  al- 
though there  is  not  much  doubt  whether  her  promiscuity  of  sex 
life  is  continuously  maintained;  in  fact,  we  are  pretty  confident 
that  in  her  periods  of  what  we  term  "normality"  she  shows 
neither  any  evidence  of  oversexedness,  nor  any  continuation  of 
sex  irregularities  as  a  matter  of  habit.  Like  Rose  Talbot,  with 
whose  case,  as  above  mentioned,  that  of  Bertha  Greenwood 
falls  somewhat  into  line.  Bertha  shows  a  kind  of  monogamous 
trend;  at  all  events  she,  for  a  long  period,  bore  in  mind  and 
descanted  upon  a  certain  married  man  with  whom  she  pro- 
claimed herself  to  have  lived  in  sex  relation.  Our  best  evidence 
is  that  this  ideal,  or  paramour,  of  Bertha's  was  fictitious.  At 
one  time  she  even  showed  a  bruise  of  the  face  which  she  said 
was  got  at  the  hands  of  this  paramour  whom,  however,  the 
police  failed  to  trace.  We  assume  that  her  tales  about  him 
sufficiently  indicate  a  degree  of  monogamous  trend.  In  general 
she  has  been,  and  is,  promiscuous  in  sex  relations,  and  has  even 
been  pregnant  twice  (abortions).  Except  at  times  of  economic 
stress,  as  after  recovery  from  influenza,  we  believe  that  Bertha 
Greenwood,  like  Rose  Talbot,  has  shown  a  large  degree  of 
self-respect,  at  least  in  the  matter  of  not  taking  money  for  her 
irregularities.  She  is  of  good  physique,  and  of  considerable 
intelligence,  at  least  of  such  a  degree  as  to  be  able  to  support 
herself  properly  in  her  normal  periods. 

Medically  speaking,  we  might  wonder  whether  the  diagnosis 
"psychopathic  personality"  was  not,  after  all,  far  more  vague 
than  two  other  diagnoses  which  we  might  be  entitled  to  make, 
namely — "hysteria"  and  "feeble-mindedness."  To  take  the 
latter,  and  simpler,  hypothesis  first,  we  find  that  she  grades 
psychometrically  on  the  Binet  Scale  at  11.3  (actual  age,  at 
the  time  of  examination,  twenty-three),  but  on  the  otiier  hand 
we  find  by  the  Yerkes  Point  Scale  that  she  grades  up  to  the 
adult  level,  or  at  least  to  fifteen  years  plus,  which  was  the  maxi- 
mum to  which  any  person  could  attain  by  the  type  of  test  then 
employed.  The  educational  test  of  the  Binet  type  probably 
yielded  poorer  record  for  Bertha  Greenwood  than  her  general 
efficiency  would  point  to ;  moreover,  we  have  in  our  possession 
a  pathography  or  partial  autobiography  written  by  her  which 
exhibits  much  more  insight  into  men,  women,  and  things  than 
a  moron  is  entitled  to  exhibit.     The  psychologists,  it  may  be 


THE    KINGDOM    OF    EVILS  7I 

stated,  despite  the  Binet  grade  of  11.3,  gave  it  as  their  opinion 
from  the  psychological  point  of  view  that  she  was  not  feeble- 
minded. It  may  be  parenthetically  stated  here  that  persons 
clearly  feeble-minded  (let  us  say  in  the  moron  division)  may 
be  sufficiently  complex  to  show  what  is  termed  psychopathic 
personality.  That  issue  we  are  not  here  raising ;  we  are  claim- 
ing for  the  concrete  case  of  Bertha  Greenwood  that  she  is  prob- 
ably not  at  all  feeble-minded  and  may  perhaps  be  an  uncompli- 
cated case  of  psychopathic  personality.  Dismissing  the  idea 
of  feeble-mindedness  in  the  metric  sense  of  that  term,  let  us 
ask  whether  we  could  further  define  the  case  by  stating  that 
Bertha  Greenwood  is  hysterical.  It  is  recognized,  on  all  hands, 
that  the  psychopathic  personality  may  show  hysterical  trends; 
that  (as  French  authorities  call  it)  there  may  be  a  forme  fruste 
of  psychopathic  personality  which  looks  in  the  direction  of 
hysteria.  We  mentioned  above  her  appearance  one  day  with  a 
bruise  on  the  face  which  she  attributed  to  her  ideal,  but  prob- 
ably fictitious,  paramour,  a  certain  married  man.  That  this 
affair  was  an  hysterical  one  might  be  thought  from  the  fact 
that  she  was  picked  up  unconscious,  or  half  unconscious.  There 
are  other,  somewhat  less  well-defined  episodes,  such  as  fainting 
spells  upon  the  street,  and  the  resort  in  wild  terror,  to  the  house 
of  a  woman  unknown  to  her.  One  night,  in  Boston,  in  fact  the 
very  first  time  that  she  devolved  upon  the  medical  scene,  she 
was  in  a  kind  of  stupor,  out  of  which  she  emerged  telling  of  her 
terror  at  a  certain  man.  Could  we  see  into  the  psychic  interior 
and  be  sure  of  our  observations,  we  might  think  of  Bertha 
Greenwood  as  leading  a  sort  of  ideal  double  life,  with  an 
idealized  monogamous  companion  of  whom  she  stood  in  a  sort 
of  fear,  that  the  light  literature  of  the  day  is  inclined  to  at- 
tribute to  the  so-called  "cave-woman." 

It  will  be  remembered  that  in  the  case  of  Rose  Talbot  syphilis 
was  early  acquired.  There  might  be  more  reason  to  suspect 
the  arrival  of  syphilis  upon  the  docket  here  than  in  the  simpler 
sex  life  of  Rose  Talbot.  Our  serum  reactions  in  Bertha 
Greenwood  have  constantly  been  negative.  This  is  despite  the 
fact  that  a  medical  consultant  in  private  practice  concluded 
from  his  examination  that  Bertha  was  suffering  from  local 
syphilitic  disease  of  the  pelvis  of  long  standing.  This  physi- 
cian went  so  far  as  to  say  that  the  nervous  side  of  Bertha's  life 
was  secondary  to  the  disease  of  her  pelvis.    He  counseled  opera- 


72  THE    KINGDOM    OF    EVILS 

tion  and  indeed  thought  such  to  be  imperative.  Another 
hypothesis  concerning  the  nervous  spells  in  Bertha  Greenwood 
is  that  they  are  due  to  dysmenorrhea. 

In  point  of  fact,  whatever  be  the  pelvic  complications  in  the 
Greenwood  case,  there  is  ample  evidence  from  her  early  life 
that  the  psychopathic  trend  far  antedates  the  immediate  effects 
of  her  sex  life.  As  a  child  she  had  hysterical  spells  of  rolling 
upon  the  ground,  and  these  began  at  about  the  tenth  year  and 
are  thought  by  the  patient  herself  to  have  followed  a  criminal 
sex  assault.  In  the  eleventh  or  twelfth  year  she  is  said  to  have 
become  subject  to  certain  sleeping  spells  about  which  we  know 
little,  although  one  of  them  is  said  to  have  lasted  for  some 
two  weeks.  Whether  these  indications  proved  hysteria  as 
against  some  more  vaguely  defined  psychopathic  entity  may 
be  left  undecided. 

Let  us  now  take  up  in  order  the  items  of  Bertha  Green- 
wood's case  distributed  amongst  the  four  fields  of  difficulty. 
It  has  been  a  classical  idea,  somewhat  shaken  by  the  war  data, 
that  hysteria  is  essentially  a  hereditary  disease,  or,  at  all  events, 
that  amongst  the  relatives  of  hysterics  will  be  found  other 
psychopathic  or  neuropathic  persons.  We  find  in  the  Green- 
wood girl  the  second  of  five  children  of  a  rather  alcoholic 
father,  who  worked  irregularly  and  finally  deserted  the  family, 
and  of  a  rather  slack  mother,  certainly  ignorant,  and  possibly 
defective.  The  family  was,  -accordingly,  constantly  known  to 
a  variety  of  agencies  such  as  The  Family  Welfare  Society,  The 
Society  for  the  Prevention  of  Cruelty  to  Children,  the  Chil- 
dren's Aid  Society,  and  the  like.  In  fact,  we  find  that  no  less 
than  thirteen  agencies  had  to  do,  at  one  time  or  other,  with  the 
members  of  this  family.  With  respect  to  heredity,  we  may 
conclude  that  neither  the  alcoholism,  nor  the  wandering  ten- 
dencies of  the  father,  nor  any  actually  known  features  of  the 
mother,  thoroughly  prove  psychopathic  heredity,  but  at  least 
there  is  a  considerable  ground  for  suspicion  thereof.  As  for 
Bertha's  own  mentality,  we  must  remain  in  doubt  whether  she 
is  finally  to  be  termed  psychopathic,  in  some  indefinite  sense 
of  the  term,  hysterical,  or  something  else.  Probably  the 
psychiatric  doubt  which  still  exists  as  to  Bertha  is  responsible, 
in  a  measure,  for  our  inability  to  handle  the  case  with  as  much 
success  as  the  hours  spent  might  seem  to  warrant. 

Physically  she  might  be  regarded  as  an  example  of  hyper- 


THE    KINGDOM    OF    EVILS  73 

thyroidism.  The  thyroid  is  palpably  enlarged,  the  pulse  is 
rapid,  respiration  is  rapid,  and  there  is  a  fine  tremor  of  the 
fingers.  Whether  this  thyroid  situation  is  secondary  to  the 
sex-gland  situation  must  remain  doubtful,  although  modern 
work  upon  the  effects  of  glandular  secretions  upon  the  tem- 
perament might  be  consistent  with  the  idea. 

If  we  turn  to  the  educational  field,  we  find  Bertha's  mother 
ignorant  and  Bertha  at  the  age  of  eight  with  three  other  chil- 
dren placed  out  in  various  homes  for  some  four  years.  There- 
upon, at  the  age  of  twelve,  she  attended  trade  school  for  a  time 
and  then  got  a  job  which  suited  her.  At  the  age  of  fourteen 
she  began  to  work  in  factories  in  and  about  Boston  and  lived 
in  lodgings,  and  at  this  time  her  sex  delinquency  began.  Some 
quotations  from  her  autobiography,  which  we  give  below,  indi- 
cate her  present  educational  status.  She,  in  practical  ways,  has 
learned  a  good  deal  and  has  become  able  to  earn  twenty-five 
dollars  a  week  in  hat-making,  and  has  held  a  variety  of  posi- 
tions, ranging  from  six  dollars  a  week  up,  for  various  periods 
of  weeks  or  months,  until  such  time  as  her  alterations  of  tem- 
perament set  in.  As  for  her  moral  training  and  status,  she  has 
always  been  an  affectionate,  though  not  always  truthful,  girl. 
She  has  rather  made  it  a  point  to  keep  her  promises.  There 
was,  as  is  frequent  with  hysterics,  a  good  deal  of  the  histrionic 
about  her  attitude;  for  example,  she  would,  half  in  earnest  and 
half  dramatically,  instigate  the  appearance  of  social  workers 
and  a  detective  upon  Boston  Common  to  meet  the  alleged  man 
who  might  be  going  to  do  her  harm.  Possibly  this  histrionic 
trend  is  more  an  intellectual  matter  than  a  matter  of  moral  at- 
titude; but  the  trend  seems  to  be  central  in  her  moral  life.  Of 
course  it  would  be  possible  to  assert  that  her  interest  in  the 
Ideal  Man  is  a  gigantic  bit  of  camouflage;  but  if  so,  this  inter- 
pretation would  only  be  in  line  with  our  general  suspicion  that 
she  is,  if  not  hysterical,  at  least  hysteroidal  in  her  make-up.  It 
is  open  to  question  how  much  proper  moral  training  she  got 
in  her  placings-out ;  or  if  she  got  proper  training  in  these  homes, 
she  may  also  have  got  much  improper  training.  Her  knowledge 
of  sex  life  she  herself  claimed  to  be  practically  nil  at  the  time 
of  her  first  intercourse,  said  to  be  at  the  age  of  sixteen  (of 
course  there  was  that  other  story  of  an  assault  at  ten).  If  we 
classify  the  patient  as  falling  importantly  into  the  group  of 
vices  and  bad  habits,  we  ought,  in  all  conscience,  to  be  able  to 


74  THE    KINGDOM    OF    EVILS 

recommend  some  proper  steps  in  moral  training  which  might 
be  taken,  or  at  the  least  show  why  further  moral  training  would 
be  fruitless.  As  a  matter  of  fact,  we  "closed"  the  case  no  less 
than  three  times  on  the  basis  of  what  might  be  termed  its  social 
incurability;  but  each  time,  at  the  patient's  request,  the  case  was 
reopened. 

One  of  our  most  powerful  lines  of  management  was  to  find 
work  and  to  secure  good  associates.  These  procedures  were 
singularly  successful  for  periods  of  a  few  weeks,  whereupon  the 
familiar  lapse  into  depression  and  into  the  necessity  or  ten- 
dencies of  sex  life  would  emerge  once  more.  The  facile  prop- 
osition for  her  disposal  would  be  to  place  her  in  some  sort  of 
new-fangled  and  perhaps  not-yet-invented  institution,  which 
could  analyze  her  with  absolute  thoroughness  and  could  secure 
some  technique  for  overseeing  the  temperamental  changes  that 
are  central  in  the  social  debacle.  We  can  put  the  question 
whether  the  irregularities  of  sex  life  are  matters  of  poor  train- 
ing, to  be  reasoned  out  by  better  education  or  smoothed  out  by 
improvements  in  tests,  standards,  companions  who  might  be 
better  models,  and  in  general  the  entire  morale.  Whatever  else 
be  true,  there  can  hardly  be  any  doubt  that  the  sex  irregularity 
is  grounded  in  something  somatic,  something  temperamental. 
Whether  this  "something  temperamental"  is  ingrained  in  the 
nervous  tissues  themselves,  i.e.,  in  the  modern  medical  lan- 
guage an  endocrine  matter,  is  doubtful. 

The  situation  with  Bertha  is  somewhat  like  that  with  Rose 
Talbot  (case  8)  ;  but  with  Bertha  there  is  far  less  of  a  nucleus 
of  self-respect  and  far  less  will-power  has  been  yet  developed 
in  her  than  in  Rose  who  in  the  end  was  made  to  acquire  the 
idea  of  "success  in  life." 

Extracts  from  an  autobiography  that  Bertha  wrote  for  the 
benefit  of  one  of  the  physicians  are  here  inserted.  Although 
falsifying  was  a  leading  tendency  with  her,  she  sticks  reason- 
ably well  to  the  truth  in  this  story  of  her  life  : — 

"It  seems  that  life  has  been  one  hard  knock  after  another. 
If  I  had  a  few  happy  days  there  were  double  the  days  of  sorrow 
afterward  to  make  up  for  the  happy  ones.  And  yet  we  must 
live  and  endure  till  the  end. 

"My  father  was  a  good  father  in  lots  of  ways,  but  like  other 
people  he  had  his  faults.  One  awful  fault  which  was  responsible 
for  all  our  unhappiness  and  the  breaking  up  of  our  happy  home 


THE    KINGDOM    OF    EVILS  J75 

was  his  liking  for  liquor.  He  drank  terribly.  I  don't  like  to 
say  it,  but  I  feel  it  is  the  truth.  My  mother  was  to  blame  for 
my  father's  drinking,  because  she  was  so  mean  to  him,  always 
nagging  and  finding  fault.  He  got  discouraged  and  didn't  care, 
then  started  to  drink  and  went  so  far  he  couldn't  stop  it.  I  can 
remember  when  my  father  was  good  and  never  drank.  He 
worked  hard  for  us  and  was  always  kind  to  Mamma  and  us 
children.  Then  too  later  I  can  remember  how  he  used  to  come 
home,  at  first  only  on  Saturday  nights  so  drunk  he  couldn't 
find  the  house  and  all  his  pay  gone.  Then  he  got  so  he  was 
always  drunk.  Poor  Dad,  it  was  .awful  and  I  am  so  sorry  for 
him.  My  mother  hates  him.  Well,  she  may  have  reasons  for 
it  that  I  don't  know  anything  about.  I  don't  think  my  father 
is  dead,  and  I  have  often  wished  I  could  meet  him  on  the 
street  sometime,  somewhere  when  I  am  out.  I  would  love  to 
see  him  again.  Poor  father.  That  is  another  thing  I  don't 
understand  in  this  life,  is  why  people  who  love  each  other  and 
should  be  happy  together  have  to  be  separated.  I  will  never 
forget  the  day  my  father  went  away  for  good.  We  were  all 
in  the  house  together  (with  the  exception  of  my  father).  My 
mother  was  sick  in  bed,  she  had  just  given  birth  to  my  sister 
Jessie,  who  was  only  a  week  old  then.  My  three  brothers  and 
I  were  in  the  kitchen  sitting  around  the  table,  telling  stories.  It 
was  early  in  the  evening.  We  were  right  in  the  middle  of  a 
story  when  we  heard  a  rap  on  the  door.  We  all  knew  it  was 
Dad,  because  he  had  a  knock  of  his  own,  three  little  taps.  We 
all  ran  to  the  door  to  let  him  in.  We  hadn't  seen  him  for  a 
week  and  we  were  awfully  glad  to  see  him  then.  My  mother 
cried  when  she  saw  him,  and  she  told  him  to  go  away  and  never 
come  back,  that  she  couldn't  have  him  around  any  longer  on 
account  of  his  drinking.  He  didn't  say  a  word,  but  we  begged 
Mamma  (as  best  we  could)  to  .give  him  another  chance.  But 
she  wouldn't.  She  told  him  to  go,  so  finally  he  started.  I  will 
never  forget  it.  We  all  clung  to  him  crying.  I  know  he  must 
have  felt  bad.  He  went  away  that  night  and  none  of  us  have 
ever  heard  from  him  or  seen  him  since.  That  left  Mamma 
with  five  of  us  children  to  take  care  of  and  none  of  us  were  old 
enough  to  work.  So  of  course  it  was  up  to  my  mother  to 
provide  for  us.  She  worked  in  restaurants  or  anywhere  she 
could  find  employment.  I  being  the  oldest  girl  most  of  the 
house  duties  fell  on  me.  I  had  to  dress  the  others  mornings 
and  get  them  off  to  the  nursery.  We  were  awful  children  and 
I  don't  blame  my  mother  for  losing  patience  with  us,  as  she 
often  did.  She  would  warn  us  to  go  to  school  in  the  morning 
before  she  went  to  work,  and  one  of  my  brothers  and  I  used  to 


76  THE    KINGDOM    OF    EVILS 

go  oiif  by  ourselves  and  play  all  day,  and  then  go  home  to 
Mamma  dirty  at  night.  We  never  even  saw  the  school  house 
from  one  day  to  another.  The  trwant  officer  was  always  after 
us  but  Ma  was  never  home  to  see  him.  Well,  we  were  proud 
kids  and  we  did  not  have  clothes  like  other  children  had,  and 
we  felt  bad  about  it,  so  thought  we  would  stay  away  from 
school.  I  remember  one  uniform  I  had,  my  mother's  shoes  size 
six.  Can  you  imagine  a  girl  of  eight  wearing  shoes  of  six,  my 
mother's  skirt  tied  around  the  waist  with  a  string  and  pulled  up 
over  the  top  to  make  it  short,  and  one  of  her  old  waists.  I  must 
have  been  a  picture,  oh  dear !  When  I  think  of  how  I  used 
to  race  the  streets  and  all  the  things  I  used  to  do  and  the  places 
I  went,  I  wonder  that  I  am  even  half  as  decent  as  I  am  today. 
Besides  not  having  clothes,  we  very  seldom  had  a  square  meal. 
We  were  always  hungry.  In  the  morning  I  always  got  up 
(because  I  was  made  to,  not  from  choice).  I  had  the  job  of 
blowing  the  fire  to  keep  it  going  to  make  a  cup  of  tea  for  my 
mother.  There  was  never  more  than  one  piece  of  wood  in  the 
house  and  often  only  one  match. 

"There  was  a  crowd  of  us  kids  who  always  went  together  on 
hikes.  One  day  my  brother  and  I  got  lost  and  Ma  found  us  in 
Cambridge  police  station.  I  was  the  only  girl,  and  there  were 
eight  boys  with  me,  two  of  them  were  colored.  When  Ma  came 
to  take  me  home  I  didn't  want  to  go.  One  of  the  policemen  had 
made  a  bed  on  one  of  the  benches  for  me  and  the  matron  had 
given  me  a  doll.  I  felt  quite  at  home  there.  It  was  much  more 
bright  and  cheerful  than  my  own  home,  even  though  it  was  a 
police  station.  I  was  always  getting  into  mischief.  One  day  I 
stole  a  red  and  white  tablecloth  l)elonging  to  one  of  our  neigh- 
bors. They  had  their  pulley  line  fastened  to  our  window  and 
I  took  the  cloth.  I  got  arrested  for  it.  The  policeman  scared 
me  and  told  me  if  I  stole  again  he  would  put  me  away.  We 
didn't  have  a  tal)lecloth  and  I  thought  it  would  be  kind  of  nice 
to  have  one.  As  long  as  we  couldn't  afford  one,  I  thought  the 
next  best  thing  was  to  steal  it,  but  I  decided  afterwards  that  it 
was  better  to  do  without  one. 

"After  a  while  Frank  and  I  were  taken  away  from  Ma  and 
put  in  a  private  family.  We  were  very  homesick.  The  people 
were  nice  to  us,  but  we  missed  the  others  at  home.  We  were 
sent  to  school  in  the  morning  and  we  went  into  the  woods  and 
stayed  till  school  was  out,  trying  to  plan  how  we  would  get  back 
to  see  Mamma.  The  people  we  lived  with  couldn't  do  anything 
with  us,  so  our  guardian  had  to  find  us  another  place  to  live. 
The  second  family  we  went  to  live  with  were  not  as  nice  to  us 
as  the  others  were  but  we  had  to  stay  there.     We  were  there 


THE    KINGDOM    OF    EVILS  77 

four  years.  We  were  on  a  farm.  We  were  awful  lonesome 
and  homesick.  Ma  only  came  to  see  us  twice  in  four  years,  and 
she  had  tickets  sent  to  her  to  go  every  month  if  she  wanted  to. 
We  went  to  school  while  with  these  people  and  helped  with  the 
work  after  school,  I  with  the  house  work  and  my  brother  with 
the  farm  work.  After  four  years  we  had  to  be  separated.  I 
had  a  chance  to  go  to  Hammond  School,  but  Ma  wanted  me  to 
go  home  and  live  with  her.  She  cried  and  took  on  so,  I  felt  bad 
for  her  and  said  I  would.  (That  was  one  step  I  took  that  I 
have  always  regretted.)  My  guardian  didn't  want  me  to  stay 
with  her,  but  I  thought  if  I  could  help  Ma  I  would,  she  had  to 
work  so  hard.  I'll  never  forget  the  first  day  I  came  home,  I 
was  so  glad  to  see  her,  I  ran  to  her  and  threw  my  arms  around 
her  neck  and  was  going  to  kiss  her.  She  pushed  me  from  her 
and  said  she  never  kissed  me  when  I  was  a  baby  and  she 
wouldn't  kiss  me  then.  I  felt  awful,  I  wanted  her  to  love  me ; 
I  was  hungry  for  love.  I  would  have  done  anything  in  order  to 
win  her  love.  But  she  didn't  care  for  me.  I  couldn't  stand  it  to 
stay  with  her.  Everything  seemed  so  upset  and  dirty  to  what 
it  had  been  in  the  country.  I  went  to  my  guardian  and  told  her 
I  couldn't  stay.  She  made  arrangements  for  me  to  go  back  and 
stay  with  the  people  I  had  been  with  for  so  long.  But  when  the 
time  came  for  me  to  go,  Ma  cried  terribly  and  begged  me  to 
stay  with  her.  I  didn't  want  to  stay  because  I  wanted  to  mak?. 
something  of  myself  and  I  knew  I  never  could  do  it  there. 
But  I  didn't  have  the  heart  to  leave  her  (another  step  in  the 
wrong  direction).  There  were  James,  Jessie  and  myself  at 
home  then.  James  and  Jessie  went  to  school  and  I  worked. 
Ma  treated  my  brother  James  so  mean  he  didn't  want  to  stay 
in  the  house  in  the  evening.  She  was  always  nagging.  He 
started  to  go  out  evenings  and  got  in  with  a  bad  crowd  of  boys. 
They  stole  something  one  night  and  all  got  arrested.  My 
brother  was  sent  to  a  reform  school.  He  stayed  there  for  a 
while  and  ran  away.  They  got  him  back  and  made  him  stay 
twice  as  long  to  pay  for  it,  and  the  poor  kid  has  been  in  reform 
schools  and  jails  all  of  his  life  since  then,  up  to  a  month  or  two 
ago,  when  he  enlisted.  He  says  now  that  as  hard  as  it  is,  it  is 
the  happiest  time  he  has  known  in  his  life. 

"My  sister  Jessie  started  to  stay  out  nights  for  the  same 
reason  my  brother  did.  I  couldn't  bear  to  see  her  have  the 
same  thing  happen  to  her  that  happened  to  James.  I  took  her  to 
Court  and  she  was  sent  to  a  private  family  to  live.  The  people 
have  adopted  her  and  as  far  as  I  know  she  has  everything  she 
wants  and  is  happy.     I  am  glad  for  her. 

"When  I  was  about  sixteen  years  old  I  went  out  of  town  to 


yS  THE    KINGDOM    OF    EVILS 

work  in  an  institution  for  my  board,  room  and  clothes,  just  for 
the  summer.  It  was  on  a  town  farm.  There  were  all  kinds  of 
people  there,  sick,  well  and  old.  The  people  who  ran  the  place 
had  four  hired  men  working  for  them.  One  of  them  liked  me 
pretty  well,  or  at  least  he  thought  he  did.  He  tried  his  best  to 
go  with  me,  but  I  wouldn't  let  him.  I  did  almost  as  bad 
though.  He  gave  me  five  dollars  not  to  say  anything  about  it 
and  I  didn't  say  anything.  I  didn't  fully  realize  then  what  it 
meant,  but  I  realized  soon  afterward.  I  liked  him  and  I  let 
him  do  that  right  along  all  the  time  I  was  there.  When  I  left 
there  I  was  always  lonesome  for  him,  but  wouldn't  give  in.  I 
came  to  New  York  and  tried  to  forget  him.  I  tried  to  find 
someone  to  take  his  place.  I  was  lonesome  and  unhappy  all 
the  time.  I  lived  with  my  mother  for  a  while,  but  she  was 
mean  to  me  and  I  left  her.  I  met  a  girl  that  I  grew  very  fond 
of.  She  liked  me  too.  She  was  older  than  L  She  was  a  bad 
girl,  but  I  didn't  care,  I  liked  her.  But  she  didn't  love  me  as  I 
wanted  her  to,  so  I  had  to  make  her  love  me.  I  didn't  care 
how  I  did  it.  After  a  time  I  told  her  I  had  gotten  in  trouble 
with  a  fellow,  so  that  she  would  sympathize  with  me.  I  knew 
she  would.  She  did,  but  I  had  to  pay  the  price.  I  had  to  go  to 
bed  and  stay  there  for  two  weeks  (until  I  was  sick).  I  had  all 
the  blankets  and  hot  water  bottles  in  creation  on  me  to  make  me 
sweat,  and  I  had  to  take  nasty  medicine  every  half  hour.  I  did 
this  all  for  love  and  I  would  not  give  in  and  tell  her  I  had  lied. 
I  bore  it  and  kept  quiet.  She  gave  me  the  affection  I  longed 
for  and  that  was  all  I  wanted.  She  was  awfully  good  to  me 
from  then  on.  I  was  quite  happy  while  I  had  her  to  go  to.  She 
satisfied  me  in  every  way  and  we  loved  each  other.  I  didn't 
want  anybody  else.  Then  she  went  away  and  I  only  hear  from 
her  now.  She  is  so  far  away  I  can't  see  her.  She  is  in  Texas. 
Since  then  I  have  never  found  anyone  to  take  her  place,  and  I 
am  lonesome  and  unhappy.  I  have  lived  an  awful  lie  and  I  can't 
get  away  from  it,  one  little  lie  has  led  to  another  till  now  it 
seems  as  big  as  a  mountain.  I  have  lied  to  so  many  people  I 
don't  know  what  I  will  ever  do,  and  everybody  thinks  I  am 
bad." 

We  have  chosen  to  regard  Bertha  Greenwood  as  a  fourfold 
rather  than  a  fivefold  case,  and  to  think  of  her  as  minus  the 
delinquency  aspect;  that  is,  the  aspect  of  legal  entanglements. 
To  be  sure,  in  one  sense  to  be  sexually  aberrant  is  to  be  a  delin- 
quent (the  terminology  is  still  a  little  doubtful),  but  we  are 
talking  of  important  spheres  of  contact  with  the  law.  There 
were  no  practically  important  legal  contacts  in  the  case.    There 


THE    KINGDOM    OF   EVILS  79 

were  one  or  two  minor  court  appearances  which  have  not  in- 
fluenced the  main  Hues  of  her  social  treatment  by  the  various 
agencies.  It  might  be  inquired  whether  the  kind  of  authorita- 
tive supervision  which  courts  could  exert  would  be  of  value  in 
such  a  case  as  Bertha's.  We  mentioned  above  that  some  sort 
of  institution  might  be  devised  that  would  help,  although  in 
such  institution  we  suspect  cases  like  Bertha's  would  have  to 
be  the  central  figures.  It  is  doubtless  unlikely  that  the  state  will 
find  itself  able  to  build  institutions  around  single  figures  of  this 
sort.  We  are  of  opinion  that,  despite  our  relative  unsuccess 
in  handling  the  case,  nevertheless  no  better  results  could  have 
been  obtained  by  judicial  methods;  that  is,  it  would  not  have 
helped  to  have  treated  this  patient  as  a  prostitute  and  to  have 
maintained  her  in  prisons  from  time  to  time  for  punitive  or 
correctional  purposes.  It  must  remain  an  open  question 
whether,  in  so  difficult  a  case,  the  "iron  in  the  velvet  glove"  that 
might  be  afforded  b}^  a  probation  system  would  have  helped. 
In  some  modern  systems,  the  psychiatric  viewpoint  is,  of  course, 
maintained. 

We  turn  to  the  economic  sphere.  Getting  her  work  was,  as 
above  stated,  one  of  our  best  lines  of  handling.  Would  Bertha 
Greenwood  have  been  another  person  had  she  been  supplied 
with  a  good-sized  annuity;  had  she  been,  in  short,  sorriewhere 
in  the  third  estate  of  the  well-to-do?  We  do  not  see  how  either 
her  histrionic  tendencies  or  her  depressive  phases,  to  say  nothing 
of  the  "man  crazy"  trends  into  which  she  would  lapse  from 
time  to  time,  could  have  been  ordered  by  a  change  of  social 
level.  Still  it  must  be  granted  that  financial  worries  may  have 
had  their  subtle  effects  upon  the  body's  functions,  and  in  some 
indirect  way  have  changed  perhaps  the  thyroid  gland,  or  even 
the  sex  life.  Perhaps  we  should  not  reckon  this  case  as  very 
fundamentally  an  economic  one.  For  example,  it  appears  that 
no  more  than  thirty-eight  dollars  were  ever  spent  out  of  avail- 
able funds  directly  upon  the  Greenwood  girl ;  still  her  psychop- 
athy, with  its  phases,  was  continually  throwing  her  upon  the 
brink  of  destitution. 

We  now  turn  from  Bertha  Greenwood  to  three  other  cases 
which  will  in  succession  demonstrate  the  fourfold  distribution 
of  the  social  evils  according  to  our  classification.  From  Thomas 
Fuller,  in  whom  the  economic  factor  did  not  come  in  question, 
and  from  Bertha  Greenwood,  in  whom  the  legal  contacts  were 


8o  THE    KINGDOM    OF    EVILS 

minus  or  slight,  we  turn  to  case  ii  (Lewis  Goldstein)  a  com- 
plicated case  of  traumatic  neurosis,  in  whom  moral  difficulties 
were  practically  nil,  to  case  12  (Elsa  Albrecht),  a  case  very 
possibly  of  dementia  praecox,  whom  we  may  regard  as  educa- 
tionally without  particular  social  flaw,  and  to  case  13  (Agnes 
O'Brien),  a  case  in  whom  the  medical  difficulties  were  subor- 
dinate or  exceedingly  slight. 

Hours  spent  by  Medical  record,  13  pages 

Social  record,  T2.  pages 
Physician,  4  Social  work : 

Visits,  133 
Psychologist,  I  Interviews  at  hospital,  19 

Telephone  calls,  80 
Social  worker,  293  Letters,  47 


TRAUMATIC  PSYCHOSIS 
FOLLOWING    INDUSTRIAL    ACCIDENT 

19 1 5  19 16 

Industrial  Disability  Compensation 

Insufficient  Income  Investment 

Debts  Business  Failure 

1917 
Irregular  Employment 
Minor  Injuries 
Charitable  Aid 

BEFORE    191 5:   illiteracy;    IRREGULAR   EMPLOYMENT; 
BUSINESS  FAILURE 


Steady,  illiterate  workman  disabled  hy  industrial  accident. 
Family  case.  Sloiu  social  recovery.  Mental  hygiene  of  in- 
dustry. 

Case  II.  We  take  up,  in  Lewis  Goldstein,  the  third  of 
our  five  cases,  showing  not  the  full  display  of  evils  in  their 
fivefold  distribution,  but  exhibiting  situations  in  some  respects 
less  complex,  namely  a  fourfold  distribution.  Whilst  Ful- 
ler (case  9)  showed  no  economic  disability,  and  whilst 
Greenwood  (case  10)  was  not,  in  any  important  way,  le- 
gally entangled,  the  present  case  of  Lewis  Goldstein  is  one  in 
which  another  element  or  factor  of  evil  was  lacking,  namely 
the  factor  of  moral  disability.  In  fact  this  young  Russian  Jew 
of  twenty-three  years  proved  to  be  a  man  of  high  moral  stand- 
ards and  ambition.  (It  would  be  almost  true  to  say,  curiously 
enough,  that  his  high  ambitions  interfered  a  little  with  his  social 
cure.)  Goldstein  was  working  as  a  roofer's  helper  one  day 
when  a  twenty-five  pound  tar  bucket  fell  from  the  fifth  floor 
upon  his  head.  He  sustained  a  compound,  depressed  fracture 
of  the  skull.  He  lived  for  a  time  upon  the  weekly  compensa- 
tion granted  him  under  the  Industrial  Accident  Laws  and  did 
no  work.  The  Industrial  Accident  Board,  not  being  sure  of  the 
degree  of  disability  or  even  of  the  existence  of  a  permanent 
injury,  sent  him  to  a  general  hospital  out-patient  department, 
whose  medical  authorities  assured  him  that  he  had  not  been 
seriously  injured  by  the  tar  bucket  and  ought  to  go  to  work 
once  more.  In  due  course  he  was  referred  to  the  Psychopathic 
Hospital  by  the  Industrial  Accident  Board,  coming,  as  is  usual 
with  these  cases,  as  a  voluntary  patient.  Here  the  psychological 
examiners  found  that  despite  his  twenty-three  years  of  actual 
age,  his  mental  age  by  the  Binet  tests  was  but  eight  and  one- 
fifth  years.  To  the  psychological  examiners  he  seemed  to  be 
a  man  of  poor  comprehension,  diminished  learning  ability,  prac- 
tically no  planning  ability  (so  far  as  tests  went),  poor  powers 
of  observation  and  apperception,  a  memory  of  narrow  span  and 
retarded  free  associations.     We  mentioned  these  details  of  the 

83 


84  THE    KINGDOM    OF    EVILS 

psychological  results  to  show  how  general,  or  as  we  are  accus- 
tomed to  say,  regular,  was  the  mental  loss ;  in  fact,  the  exceed- 
ingly competent  examiner  thought  that  Goldstein's  reactions 
throughout  were  those  of  a  feeble-minded  person  of  low  moron 
grade. 

Now  such  results  obtained  by  the  psychologists  are,  in  these 
cases,  of  extreme  value,  particularly  when  we  come  to  com- 
pare the  results  of  one  year  with  those  of  later  years.  Some- 
times it  is  possible  to  trace  the  improvement  of  a  patient  recov- 
ering from  brain  injury  most  precisely  by  means  of  successive, 
properly  spaced,  psychological  tests,  but  in  the  present  mstance, 
the  psychiatric  social  worker  examining  the  man's  past  would 
have  been  entitled  to  wonder  how  the  diagnosis  of  low  moron 
could  have  been  made  in  a  man  who  had  been  reasonably  suc- 
cessful in  a  variety  of  positions  and  had  even,  at  one  time, 
managed  a  small  business.  He  had  been  a  steady  and  depend- 
able fellow  of  good  habits,  cheerful,  even-tempered,  fond  of 
his  family.  At  a  pinch  it  would  appear,  however,  that  every- 
thing he  had  actually  undertaken  to  do  could  have  been  per- 
formed by  a  moron  of  a  high  grade.  It  would  be  a  pretty  in- 
quiry, and  one  which  should  be  carried  out  by  scientific  employ- 
ment managers  or  the  administrators  of  business  schools,  to 
classify  types  of  occupation,  particularly  industrial  occupation, 
with  respect  to  the  degree  of  mental  capacity  necessary  for 
their  carrying  out.  Possibly  many  of  these  industrial  occupa- 
tions range  in  their  mental  age  capacity  around  ten  years. 
Goldstein,  however,  made  eight  and  one-fifth  years. 

Accordingly,  although  the  mental  level  and  the  manner  of 
its  reduction  both  signify  feeble-mindedness,  the  social  inquiry 
inclines  us  to  the  belief  that  either  the  accident,  or  some  other 
element  in  Goldstein's  history,  had  reduced  his  mental  level 
somewhat.  The  psychiatrist,  reporting  upon  Goldstein  to  the 
Industrial  Accident  Board,  putting  together  the  psychological 
and  sociological  data,  said  that  "accordingly  it  seems  doubtful 
whether  the  patient  could  have  been  a  low-grade  moron  before 
his  accident  and  that  it  is  probable  that  the  accident  is  a  large 
factor,  if  not  the  entire  factor,  in  his  present  condition." 

The  medical  examination  showed  some  evidence  of  a  skull 
depression  in  the  u])per  occiput  and  there  was  a  minor  disorder 
of  the  reflexes  upon  the  right  side  of  the  body,  comporting 
with  the  probable  site  of  the  brain  injury  inflicted  by  the  tar 


THE    KINGDOM    OF    EVILS  85 

bucket.  Upon  investigation,  it  appeared  that,  after  being  struck 
down  by  the  bucket,  he  had  become  unconscious,  was  cared 
for  six  days  at  the  Rehef  Station,  became  bhnd  a  few  days, 
later  was  cared  for  at  a  general  hospital,  and  thereafter  had 
been  in  bed  for  a  period  of  five  or  six  weeks,  so  that  the  total 
history  of  bed- fast  debility  was  something  like  two  months. 

The  prognosis  given  by  the  hospital  was  that  "the  patient 
cannot  at  present  work,  and  for  some  time  he  will  be  unable  to 
make  anything  like  eighteen  dollars  a  week"  (his  wages  as  a 
roofer's  helper). 

Although  this  is  not  a  textbook  of  psychiatry,  it  may  be  of 
interest  to  the  reader  to  learn  how  many  symptoms  such  a 
patient  as  Goldstein  may  show  between  eight  and  nine  months 
after  injury.  He  came  to  the  Psychopathic  Hospital  complain- 
ing of  insomnia,  of  loss  of  appetite,  of  backache,  of  an  almost 
constant  headache ;  his  vision  was  greatly  impaired  and  he  was 
most  seriously  troubled  with  attacks  of  blindness  that  would 
last  a  few  minutes  and  be  attended  with  dizziness.  He  would, 
under  such  circumstances,  fall  into  the  street  and  then  take  to 
weeping.  He  had  become  restless,  irritable,  readily  angered  by 
trifles,  and  thereafter  lachrymose.  His  incapacity  to  earn 
money  made  him  depressed  and  apprehensive.  He  described 
himself  as  having  a  tendency  to  chills  and  said  that  his  memory 
was  impaired.  Several  features  of  this  catalogue  of  symptoms 
belong  to  the  so-called  vasomotor  neuroses  of  certain  authors, 
characteristically  found  after  injury;  the  facile  spells  of  anger 
perhaps  belong  to  the  so-called  explosive  diathesis  of  authors. 
Upon  these  data,  the  Industrial  Accident  Board,  after  a  time, 
fixed  a  lump  sum  settlement,  and  the  money  awarded  was  put 
into  a  small  store.  The  business,  however,  failed  in  a  few 
months.  Possibly  its  failure  was  due  to  the  patient's  becoming 
upset  by  complications  following  his  wife's  pregnancy  and  con- 
finement in  a  hospital.  He  shortly  became  well  enough  again 
to  work,  but  refused  to  take  a  job  that  paid  less  wages  than 
he  was  used  to. 

We  had  Goldstein  under  supervision  for  some  three  years. 
By  slow  degrees  he  got  back  to  habits  of  regular  work  in  his 
oH  roofer's  trade.  About  three  years  ago  (1918)  the  case  was 
closed,  partly  because  other  cases  seemed  to  demand  more  from 
the  social  service  than  did  Goldstein's.  As  a  matter  of  the 
technique  of  social  work,  it  is  interesting  to  point  out  that  no 


86  THE    KINGDOM    OF    EVILS 

fewer  than  eleven  agencies  were  called  upon  to  deal  with  Gold- 
stein. No  single  relief  agency  was  available  that  could  supply- 
all  the  funds  necessary  for  his  family,  which  was  ever  on  the 
poverty  line.  Steady  relief  for  the  rest  of  the  family  would 
have  been  the  ideal  background  for  the  psychiatric  social  worker 
in  the  Goldstein  case,  but  it  is  permissible  to  point  out  that 
there  would  have  been  no  family  problem  of  moment  had  there 
not  been  a  central  psychopathic  figure  on  the  scene,  namely  the 
traumatic  neurosis  or  psychosis  of  the  bread-winner.  At  one 
time  we  attempted  to  transfer  the  Goldstein  family  relief  ques- 
tion to  a  general  relief  agency,  but  the  psychiatric  features  of 
the  whole  situation  failed  to  be  grasped  by  that  relief  agency 
and  the  case  had  to  be  reopened  by  us. 

Certain  minor  psychopathic  complications  are  worth  a  word. 
Thus,  the  man's  feeble-mindedness,  or  queer  equivalent  thereto, 
had  something  to  do  with  the  temporariness  of  his  different 
jobs.  Thus  Goldstein  might  promise  to  apply  for  some 
vacancy  and  then  do  nothing  further  about  it;  then  again  he 
would,  in  working,  run  a  nail  into  his  foot,  or  strain  his  back, 
or  fracture  his  wrist,  in  fact  have  so  many  kinds  of  accident 
that  there  can  be  little  doubt  that  the  complications  were  largely 
due  to  his  low  mental  capacity.  It  is  this  kind  of  thing  which, 
in  industry,  would  go  to  make  up  a  genuine  problem  that 
might  be  called  the  nienfol  hygiene  problem  in  industry,  for 
it  is  clear  that  feeble-minded  persons  who  have  not  had  their 
mentalities  diminished  by  the  fall  of  tar  buckets  on  their  heads, 
may  nevertheless  very  frequently  be  subject  to  accident.  Of 
course,  throughout  all  this  talk  about  Goldstein's  feeble-mind- 
edness, it  must  be  remembered  that  he  is  a  fairly  well  built,  well 
developed,  v/ell  nourished  man  who  presented  so  good  a  gen- 
eral appearance  that,  no  doubt,  any  employer  would  be  in- 
clined, and  properly  inclined,  to  hire  him  on  sight. 

Our  analysis  of  Goldstein  from  the  standpoint  of  the  dis- 
tribution of  troubles  may  be  brief.  The  medical  features  dom- 
inate, whether  on  the  one  hand  we  point  to  Goldstein's  original 
moronity  or  to  his  queer  lack  of  mental  capacity.  The  educa- 
tional disability  was  not  alone  that  of  the  feeble-minded  person, 
but  was  also  that  of  the  Russian  immigrant.  With  respect  to 
vices  and  bad  habits  we  can  find  no  evidence  thereof,  except 
phenomena  that  might  be  explained  more  readily  on  the  patho- 
logical, or  poor  education,  basis.    The  legal  entanglements  with 


THE    KINGDOM    OF    EVILS  87 

the  Industrial  Accident  Board  had  a  strong  bearing  upon  the 
rate  of  social  "cure"  and  medically  there  is  at  least  a  strong 
suspicion  that  the  law's  delay  contributed  not  a  little  to  the 
fixation  of  his  neurosis.  Economically  he  was  forced  to  drop 
from  eighteen  or  twenty  dollars  per  week  to  nine  dollars  per 
week.  When  the  lump  sum  melted,  Goldstein  was  worse  off 
than  before.  It  is  plain  that  all  the  phenomena  in  this  case 
are  so  closely  bound  up  with  one  another  that  the  cure  or 
removal  of  no  single  element  in  the  complex  will  turn  the 
trick  completely. 

Shall  we  regard  him  as  a  "successful"  case  of  psychiatric 
social  work  ?  As  hinted  above,  we  should  not  have,  under  ideal 
conditions,  closed  Goldstein's  case.  At  all  events,  we  must  say 
that  he  is  decidedly  upon  the  up-gradient  once  more.  Whether 
we  attribute  this  improvement  to  subtle  mind  changes  due  to 
the  passing  of  the  effects  of  his  brain  injury  three  years  before, 
or  whether  we  attribute  the  up-curve  to  environmental  effects 
of  assiduous  social  work  may  and  ought  to  be  left  undecided. 
We  say  "ought"  to  be  left  undecided  because  scores  more  of 
such  cases  as  Goldstein's  ought  to  be  on  the  social  work  record 
books  of  the  world.  Had  not  eleven  agencies  had  to  do  with 
Goldstein,  and  had  not  the  thread  of  psychiatric  insight. been 
shown  in  the  social  work,  it  is  easy  to  picture  the  collapse  in 
several  fields  of  social  trouble  of  the  entire  family. 

Hours  spent  by  Medical  record,  yj  pages 

Social  record,  41  pages 
Physician,  11  Social  work: 

Visits,  61 
Psychologist,  i  Interviews  at  hospital,  9 

Telephone  calls,  50 
Social  worker,  io6>^  Letters,  10 


Mother  of  two  illegitimate  children.  Mental  disease  sus- 
pected.    Referred  as  a  ''terrible  case." 

Case  12.  The  fourth  of  our  five  cases  that  are  less  com- 
plex by  one  element  than  Rose  Talbot  (case  8)  is  the  case  of 
Elsa  Albrecht,  who  came  under  our  observation  first  at  the  age 
of  twenty-six.  This  case  is  one  free  from  educational  defi- 
ciency, and  is,  in  fact,  a  girl  of  rather  superior  education.     She 


55  THE    KINGDOM    OF    EVILS 

came  to  us  as  of  the  group  sometimes  referred  to  as  "terrible." 
During  her  three  years  in  this  country  she  had  had  two  illegiti- 
mate children.  She  could  hold  no  job;  she  was  very  shifty 
and  undependable  in  her  accounts  of  her  life:  her  responsibil- 
ity was  a  grave  matter  of  question.  As  for  the  illegitimacies, 
she  showed  little  or  no  concern  over  them,  nor  was  the  truth 
ever  learned  concerning  them.  To  make  a  long  story  short, 
she  was  eventually  dismissed  from  the  Psychopathic  Hospital 
with  the  diagnosis  of  "paranoid  dementia  praecox,"  a  diagnosis 
which  should  probably  be  revised  on  the  basis  of  further 
observation. 

We  find  in  the  hospital  the  following  evidence  which  under- 
lay the  diagnosis  that  we  now  regard  as  erroneous :  The  little 
concern  which  she  showed  over  the  illegitimacies,  irritability, 
resistiveness,  overemotionality,  hallucinations  (history  of  three 
years'  standing),  double  thinking  (heard  her  own  thoughts). 
Psychometrically  she  was  regarded  as  of  adult  mental  age, 
tested  by  norms  for  non-English-speaking  persons.  Perhaps 
the  most  striking  feature  in  the  psychiatric  situation  was  the 
alleged  hallucinations.  She  claimed  to  hear  distinctly  the  voice 
of  some  unknown  woman  and  sometimes  other  voices  that 
were  talking  about  her  in  English,  French,  or  German.  When 
the  question  of  voices  was  brought  up  with  her  she  would  grow 
somewhat  disturbed.  Toward  the  close  of  her  stay  she  said 
that  she  was  not  now  hearing  these  voices  so  much  since  con- 
fessing about  a  false  name  that  she  had  used.  She  talked  more 
or  less  about  her  conscience  and  its  troubling  her  about  this 
assumption  of  a  false  name  and  of  "voices"  accusing  her  of 
being  false  to  herself  and  to  God.  Whether  we  are  dealing 
with  definite  hallucinations  of  hearing  or  whether  we  are  deal- 
ing with  pseudo-hallucinations  is  a  fine  psychiatric  question, 
but  it  would  not  do  medically  to  ground  a  diagnosis  of  demen- 
tia praecox  upon  so  slender  a  basis. 

This  diagnosis  of  dementia  praecox  must  be  accepted  as  a 
serious  thing  in  any  social  case,  for  once  let  the  diagnosis 
dementia  praecox  be  grafted  on  any  case  and  a  sort  of  taint 
seems  to  cling  to  the  case  for  all  time.  This  is  no  doubt  largely 
on  account  of  the  sweeping  implications  of  the  term  "dementia." 
Where  the  case  should  be  put  medically  remains  in  doubt.  We 
are  certain  of  many  of  the  so-called  psychogenic  features,  fea- 
tures that  are  found  to  some  extent  probably  in  all  kinds  of 


THE    KINGDOM    OF    EVILS  89 

mental  disease,  but  which,  when  developed  alone  and  inten- 
sively, place  their  victim  somewhere  in  the  group  of  the  psycho- 
neuroses  or  the  psychopathic  personalities  with  psychogenic 
features. 

Rather  unlike  the  victim  of  dementia  praecox,  and  rather 
more  like  sundry  of  the  psychoneurotics,  Elsa  made  friends 
easily  and  even  lay  friends  stuck  by  her  through  thick  and 
thin,  and  especially  through  the  complications  of  the  two  illegiti- 
mate births.  Although  she  made  Jay  friends  so  easily,  Elsa 
was,  in  the  eyes  of  social  agencies,  a  good  deal  of  a  menace, 
perhaps  the  more  so  as  she  made  friends  so  readily.  At  one 
time  an  attempt  was  made  to  deport  Elsa  as  an  undesirable  alien. 
However,  upon  investigation,  it  appeared  that  she  had,  after 
all,  taken  fair  care  of  her  children  for  whom,  indeed,  she  never 
failed  to  exhibit  her  love.  Amongst  other  contrasts  with  which 
this  case  was  so  rife  we  should  mention  Elsa's  own  division 
of  mind  over  herself,  her  future,  and  her  children.  She  was, 
for  the  most  part,  self-confident  in  asserting  her  ability  to  care 
for  herself  and  her  children,  worked  as  a  governess  to  support 
them,  and,  for  a  long  time,  held  the  ideal  of  bringing  them  up 
as  sisters  should  be  brought  up ;  namely,  together.  Again  she 
showed  a  deep  depression,  in  fact,  such  a  degree  of  emotionality 
as  was  suited  to  her  situation  so  that  the  psychiatrist  would 
very  naturally  question  her  being  a  victim  of  dementia  praecox. 
Another  contrast  in  Elsa's  case  was  that  between  her  excellent 
general  intelligence  and  her  inability  to  keep  a  job.  It  might 
even  be  thought  that  a  slight  degree  of  wandering  tendency 
was  herein  shown,  although  the  obvious  cause  for  each  loss  of 
a  job  seemed  to  be  matters  of  her  high  temper  and  inability 
to  stand  critique.  As  intimated  above,  perhaps  the  strongest 
contrast  lay  between  her  general  self-respect  and  her  curious 
light-heartedness  concerning  the  illegitimate  births.  She  ex- 
plained that  she  was,  in  each  case,  engaged  to  her  lover  and 
seemed  to  feel  that  these  sins  were  comparatively  minor. 

The  history  of  the  social  care  of  Elsa  Albrecht  is  rather 
unusually  exciting  because  of  factors  thrust  in  from  without. 
Somehow  Elsa  veered  from  her  attitude  of  keeping  the  children 
together  for  their  growing  up  and  decided  to  have  them  both 
adopted,  if  possible.  The  older  girl,  now  four  years  old,  was 
adopted  by  friends.  The  younger  one,  now  two  years  old, 
went  through  the  process  of  adoption,  but  there  came  about  an 


90  THE    KINGDOM    OF    EVILS 

annulment  in  the  following  manner :  When  these  sudden 
developments  forthwith  came  to  the  attention  of  the  social 
workers,  the  warning  was  given  to  the  intermediator  for  the 
younger  child  (who  happened  to  be  a  physician)  that  the  foster 
mother  might  properly  know  something  of  the  situation.  The 
physician  agreed  readily  with  this  idea,  and  in  fact,  set  about 
forthwith  to  have  the  adoption  annulled.  Whether  Elsa  had 
at  this  time  contemplated  the  marriage  with  an  Oriental  that 
she  now  promptly  executed  is  in  doubt;  at  all  events  what  hap- 
pened was  that  she  went  to  a  distant  city  and  got  work.  The 
social  technique  consisted  in  requiring  her,  on  moral  grounds, 
to  come  back  and  assume  responsibility  for  the  now  unadopted 
baby.  She  came  back,  took  the  baby,  and  repaired  once  more 
to  the  distant  city,  where  she  married.  The  baby  was  then 
placed  out,  and  provision  made  for  her  board  to  be  paid  for  by 
the  husband. 

As  a  matter  of  the  progress  of  psychiatric  social  work  in  the 
country,  it  is  interesting  to  know  that  we  were  able  to  get 
cooperation  with  workers  in  the  city  where  Elsa  now  is,  so 
that  due  attention  could  permanently  be  paid  to  the  upbringing 
of  the  child  and  to  any  complication  which  might  ensue  in  the 
married  life  of  a  woman  who  seems  to  be  undoubtedly  some 
sort  of  psychopath.  After  an  interval  of  two  years  the  follow- 
ing report  came  from  the  social  agency  : — 

"We  have  had  a  report  on  this  case  within  the  last  month 
showing  that  the  patient  is  fairly  happy  in  her  home  which  is 
comfortably  furnished  and  well  kept.     You  must  have  had  a 

previous  report  on  her  marriage  to  Mr.  R ,  her  subsequent 

worry  over  the  fact  that  he  did  not  make  as  much  money  as  he 
did  prior  to  their  marriage,  and  also  her  upset  over  the  death 
of  her  youngest  child,  Gretchen.  In  October,  1918,  she  had 
frequent  fits  of  crying  and  was  grieving  over  the  death  of  this 
child  and  the  adoption  of  Frieda  the  older  one.  In  May,  1919, 
she  gave  birth  to  a  little  boy,  Charles.  The  birth  of  this  child 
has  seemed  to  compensate  her  for  the  loss  of  the  other  two. 
Her  husband  is  now  in  a  better  financial  position  than  formerly; 
and  when  the  patient's  children  were  spoken  of  she  showed  no 
emotion  whatever  and  seemed  to  have  no  regret  for  the  death 
of  the  one  nor  the  adoption  of  the  other.  She  was  very  affec- 
tionate to  her  new  baby  and  seemed  very  proud  of  it.  About 
three  weeks  ago  she  wrote  us  that  the  baby  was  progressing 


THE    KINGDOM    OF    EVILS  9 1 

satisfactorily,   is  now  walking  and  talking  and  she  herself   is 
getting  along  nicely  with  her  husband  and  is  in  good  spirits." 

To  sum  up  from  the  standpoint  of  the  distribution  of  evils, 
we  have  here  a  medical,  moral,  legal,  and  economic  problem, 
without  important  educational  complications. 

Hours  spent  by  Medical  record,  17  pages 

Social  record,  17  pages 
Physician,  3^  Social  work: 

Visits,  7 
Psychologist,   i  Interviews  at  hospital,  15 

Telephone  calls,  45 
Social  worker,  28  Letters,  31 


MORON,  29 
HYSTERICAL,  POOR  HOUSEKEEPER 


1915-1916 
Forced  Marriage 
Jealousy :     Separation 
Another  Child 

Estrangement  from  Relatives 
Unemployed 


igi6-igiy 

Child  with  Husband'^ 

Relatives 
Under  Public  Care 
Reconciled 
Employed 


Hysterical  moron,  divorced,  with  an  illegitimate  child.  Such 
cases  often  known  to  social  agencies. 

Case  13.  It  is  now  our  duty,  for  the  sake  of  logical  com- 
pleteness, to  describe  a  case  without  special  medical  complica- 
tions, but  one  which  shall  show  the  four  other  types  of  com- 
plication with  which  we  have  become  familiar.  In  a  book  on 
social  psychiatry  it  is,  of  course,  in  the  strict  sense  not  proper 
that  we  should  describe  any  non-psychiatric,  or  indeed  non- 
medical, cases.  Agnes  O'Brien  did  show,  as  a  perfectly  proper 
ground  for  her  appearance  at  the  Psychopathic  Hospital,  an 
attack  which  it  is  probably  safe  to  regard  as  hysterical;  but 
thereafter  her  social  care  contained,  although  many  difficult,  no 
special  medical  complications. 

Let  us  at  first  make  her  out  as  medical  and  psychiatric  as 
possible.  When  she  arrived,  it  was  with  a.history  that  her  face 
had  become  twisted;  that  she  was  unable  to  chew  or  swallow 
and  that  she  had  been  crying  a  good  deal.  These  things  had 
been  going  on  for  a  day.  She  said  she  was  going  to  commit 
suicide  by  taking  poison;  she  said  she  was  going  to  throw  a 
pocketbook  into  the  fire.  Her  sister-in-law  thought  that  Agnes 
hardly  knew  what  she  was  doing.  She  was  a  rather  frail 
woman  of  twenty-nine  who  looked  almost  girlish.  Her  sister- 
in-law  said  that  five  years  ago,  when  pregnant,  Agnes  had  had 
somewhat  the  same  symptoms.  It  seemed  plain  that  they  were 
hysterical  in  part.  Examination  showed  that  the  girl  was 
pregnant.  Detailed  medical  examination  showed  the  con- 
tracted or  tubular  vision  characteristic  of  hysterics.  Although 
Agnes  claimed  that  she  was  unable  to  speak,  and  spoke  of  oc- 
casional paralysis  of  one  side  of  her  face,  it  was  found  that, 
when  her  attention  was  distracted,  she  could  enunciate  per- 
fectly and  showed  no  sign  of  facial  paralysis  whatever. 

Thus,  the  first  medical  point  to  make  is  that  the  patient  was 
clearly,  though  mildly,  hysterical.  The  psychological  exam- 
ination showed  that  she  was  a  subnormal  person  grading  at 
1 1.3.     Her  grading  was  fairly  even;  that  is,  she  showed  the 

95 


g6  THE    KINGDOM    OF    EVILS 

"truncate"  deficiency  of  mind  which  is  more  characteristic, 
statistically  speaking,  of  feeble-mindedness  than  it  is  of  ac- 
quired mental  disease.  Perhaps,  therefore,  we  should  classify 
her  as  a  more  complicated  case  of  social  trouble ;  namely,  as  the 
fivefold  case  in  which  medical,  as  w^ll  as  educational,  moral, 
legal,  and  economic  difificulties  confront  the  social  adapter. 
However,  we  are  convinced  that  many  a  social  agency  deals 
on  non-medical  grounds,  and  certainly  upon  non-psychiatric 
grounds,  with  case  after  case  of  this  order.  We  believe  that  the 
records  of  social  agencies  the  country  over  will  be  found  to 
contain  such  cases  as  Agnes  O'Brien's  treated,  and  with  con- 
siderable or  perfect  success,  by  the  usual  social  technique. 
When  perfect  success  is  achieved  in  cases  of  this  order,  appar- 
ently from  a  non-psychiatric  angle,  we  suspect  that  the  technique 
implied  is,  at  bottom,  that  of  the  psychiatric  social  worker.  In 
the  practice  of  social  work,  and  especially  in  the  practice  of 
medical  social  work,  the  psychiatric  viewpoint  sometimes  gets 
implanted  subconsciously  in  the  social  worker's  mind.  It  is  a 
part  of  the  program  for  progress  in  psychiatric  social  work  to 
point  out  the  tremendous  percentage  of  situations  demanding 
social  work  that  encloses  as  a  core  some  psychopath.  Concern- 
ing Agnes  O'Brien,  we  then  insist  that  her  case  is  not  an  unfair 
sample  of  cases  handled  sometimes  successfully,  perhaps  more 
often  unsuccessfully,  by  agencies  that  employ  neither  the  medi- 
cal point  of  view  nor  the  psychiatric  point  of  view. 

The  social  technique  had  to  take  account,  for  Agnes  O'Brien, 
of  some  place  in  wliich  she  could  await  her  confinement.  The 
attitude  of  the  family,  especially  of  the  in-laws,  was  not  too 
pleasant,  as  might  be  supposed  when  it  is  noted  that  the  preg- 
nancy was  illegitimate.  The  priest's  interest  was  enlisted. 
The  first  pregnancy,  five  years  before,  had  led  to  a  forced 
marriage,  and  now  that  the  new  child  was  on  the  way  by 
another  father,  there  was  a  threat  of  divorce  by  the  husband. 
The  legitimate  child  required  care.  This  was  managed  by 
placing  the  child  with  the  husband's  relatives.  Prenatal  care 
was  arranged  for.  Care  during  the  confinement,  care  of  the 
baby  in  its  early  days,  and  placing-out  of  the  baby,  were  other 
steps.  It  was  a  little  hard  to  convince  the  municipal  authorities 
that  this  seemingly  relatively  normal  mother  could  not  well  take 
care  of  the  new  child.  However,  the  child  was  finally  placed 
out.     There  was  also  the  important  question  of  proper  counsel 


THE    KINGDOM    OF    EVILS  97 

and  encouragement  for  the  woman  herself.  Aside  even  from 
the  complication  of  her  pregnancy,  Agnes  O'Brien  was  a  rather 
frail,  inert  person,  a  little  sullen  and  stubborn.  At  the  end  of  a 
year  the  situation  was  somewhat  as  follows :  The  legitimate 
child  was  under  the  care  of  her  husband's  relatives;  the  illegiti- 
mate child  was  under  public  care ;  the  girl  had  become  recon- 
ciled with  her  own  relatives,  and  to  some  extent  with  her  hus- 
band's relatives.  She  could,  from  time  to  time,  see  her  child 
with  them.  She  can,  of  course,  also  see  her  child  that  is  under 
public  care.  ( Parenthetically  we  may  remark  that  the  monthly 
or  bi-monthly  "pass"  system  by  which  children  under  public 
care  are  allowed  to  come  to  the  vision  of  their  mothers  by  the 
public  authorities  of  some  of  these  institutions  may  be  a  neces- 
sary, but  certainly  seems  a  somewhat  inhuman  system :  the  bet- 
ter agencies  so  individualize  their  systems  that  the  parents  who 
would  not  be  disturbing  elements  in  the  foster  situations  are 
allowed  due  access.)  Agnes  is,  for  the  most  part,  sufficiently 
devoted  to  her  children,  at  least  to  the  first,  or  legitimate  child, 
yet  her  temperament  is  such  that  a  letter  of  the  following 
description  was  sent  to  her  husband : — 

"Dear  William  :  As  long  as  you  don't  intend  to  do  the 
straight  thing  by  me,  I  don't  by  you.  So  come  up  and  get  your 
old  kid  or  I  will  leave  her  some  where  on  the  street.  I  am  half 
dead  from  everything  and  can't  stand  taking  care  of  her  any 
longer.  Don't  send  that  rotten  old  Jew  up  to  me  Saturday  or 
I  will  insult  him.  I  can't  give  him  any  money  and  try  to  pay 
back  milk  bills  and  back  rent  and  everything.  Come  take  your 
kid  quick  or  you  will  see  what  I  will  do  with  her.  I  am  smash- 
ing her,  she  is  a  regular  pest.  If  I  am  going  to  live  by  myself 
I  can't  have  a  good  time  with  her  tagging  after  me. 

"Your  neglected 
"Wife." 

But  these  sentiments  oi  me  neglected  wife  are  entirely  incon- 
sistent with  her  actually  idolizing  the  child. 

Shall  we  regard  the  analysis  of  this  case  as  essentially  free 
from  medical  factors?  It  is  facile  enough  to  point  out  the 
moronity  of  this  girl  and  say  that  feeble-mindedness  leads  to 
such  complications  as  forced  marriages  and  illegitimacies,  yet 
it  would  be  more  accurate  to  say  that  feeble-mindedness  is  not 
infrequently  followed  by  such  complications.     Certainly,  how- 


98  THE    KINdDOM    OF    EVILS 

ever,  no  one  can  fail  to  be  aware  of  sundry  equally  moving 
instances  of  forced  marriage,  illegitimacy,  etc.,  that  dot  the 
lives  of  persons  that  are  not  feeble-minded,  possibly  not  even 
psychopathic.  Whatever  be  the  truth  of  these  contentions,  we 
present  the  case  as  one  in  which  four  types  of  factor  are  pre- 
dominantly in  evidence,  whereas  the  fifth,  or  medical,  factor  did 
not  particularly  influence,  save  in  the  most  subtle  way  perhaps 
the  social  treatment. 

Hours  spent  by  Medical  record,  15  pages 

Social  record,  s^  pages 
Physician,  4^  Social  work  : 

Visits,  43 
Psychologist,  i  Interviews  at  hospital,  8 

Telephone  calls,  34 
Social  worker,  86  Letters,  25 


Deaf,  syphilitic,  unstable.  Abusive  and  psychopathic  hus- 
band. 

Case  14.  With  case  14  we  begin  our  group  of  threefold 
cases ;  namely,  cases  in  which  two  of  the  five  fields  of  social 
trouble  are  not  predominantly  in  evidence,  and  we  choose,  for 
the  first  case,  one  with  medical,  educational,  and  moral  diffi- 
culties, but  without  special  legal  or  economic  disabilities.  The 
case  is  that  of  Margaret  Hersey,  whose  social  symptoms 
might  be  listed  as  follows :  Marital  discord,  seclusiveness, 
deafness,  suspiciousness.  Margaret  was  an  illegitimate  child. 
Her  husband  was  a  sex  delinquent  and  one  of  her  stepsons  was 
also  a  sex  delinquent.  It  is  of  note  ( re  general  progress  in  the 
mental  hygiene  of  the  community)  that  Margaret  Hersey  came 
to  the  attention  of  the  social  service  indirectly.  First  came  to 
us  the  delinquent  stepson  who  had  gotten  into  some  sex  diffi- 
culties, not  here  to  our  point. 

Abstracting,  for  the  moment,  from  the  difficulties  of  the 
rest  of  the  family,  let  us  consider  the  situation  depicted  in 
marital  discord,  seclusiveness,  deafness,  and  suspiciousness. 
The  psychiatric  viewpoint  would  immediately  try  to  connect  up 
some  of  these  phenomena.  Psychiatrists  believe  that  there  is 
actually  to  be  found  in  the  world  at  times  a  so-called  "psycho- 


THE    KINGDOM    OF    EVILS  99 

sis  of  the  deaf";  that  is,  a  more  or  less  well-defined  mental 
disease  directly  depending  upon  sense-deprivation,  viz.,  deaf- 
ness. But  psychosis  of  the  deaf  is  not  actually  in  question  with 
Mrs.  Hersey.  The  deafness  was  extreme  enough  and  made 
communication  very  difficult  with  other  members  of  the  family. 
Mrs.  Hersey  may  have  been,  to  start  with,  a  Httle  paranoid; 
that  is,  given  to  ideas  of  being  put  upon,  of  being  persecuted. 
If  so,  the  at  first  indefinite  ideas  of  persecution  were,  no  doubt, 
driven  further  into  her  make-up  by  the  deafness  and  her  lack 
of  power  to  verify  or  disprove  sundry  hypotheses  about  her 
husband  and  son. 

Mrs.  Hersey  had  been  married  at  the  age  of  twenty  and  was 
now  thirty-eight.  The  very  first  night  of  her  marriage,  her 
husband  was  violent  and  abusive,  and  from  him  she  promptly 
also  contracted  syphilis.  Whether  her  deafness  is  syphilitic 
remains  in  question.  It  began  about  eight  years  after  her  mar- 
riage and  grew  worse  some  years  later  after  her  husband  had 
struck  her  a  bad  blow  upon  the  head.  At  one  time  (age  thirty- 
three)  the  poor  woman  even  attempted  to  commit  suicide. 

Medical  examination  showed  that  Mrs.  Hersey  had,  besides 
sundry  minor  nervous  symptoms,  a  positive  Romberg  sign 
and  an  ataxia  of  gait,  both  signs  suggesting,  with  the  rest  of 
her  history,  a  syphilitic  involvement  of  her  nervous  system. 
In  fact  she  had  been  treated  at  two  general  hospitals  for  this 
complication  of  syphilis,  and  at  the  time  when  she  came  under 
Psychopathic  Hospital  observation  her  spinal  fluid  had  become 
negative — a  finding  which  does  not  necessarily  show  that  there 
is  not  still  some  active  syphilis.  There  were  also,  in  her  history, 
two  miscarriages,  which  might  be  thought  consistent  with  the 
history  of  syphilis  (though  one  of  these  miscarriages  followed 
a  trolley  accident). 

Deafness,  incommunicability,  suspiciousness,  seclusiveness, 
formed  a  complex  serious  enough  in  itself ;  but  it  appears  that 
from  time  to  time  she  also  had  definite  hallucinations  of  hear- 
ing, hallucinations,  however,  which  she  quite  well  understood 
to  be  perceptions  of  an  imaginary  character. 

Our  investigations  showed  that  the  family  was  economically 
upon  a  reasonably  high  level  and  that  with  proper  family  coun- 
sel that  level  could  be  well  maintained.  Perhaps  we  can  indi- 
cate the  kind  of  social  treatment  adopted  in  this  case  by  the 
following  notes ;— 


lOO  THE    KINGDOM    OF    EVILS 

9/28  Interview  with  husband  to  assist  in  persuasion  for  ex- 
amination. 
10/  I  Interview  with  patient.     Reassurance. 
10/  2  Interview  with  patient's   mother.      Encouragement  and 

advice. 
10/  7  Interview   with  husband.      Attempt  to   improve  insight 
into  patient's  condition.     SHght  gain  in  cooperation. 
"       Interview  with  patient's  son.     Object:  To  appeal  to  his 

sense  of  chivalry. 
"       Interview  with  patient's  daughter.     Object:  To  suggest 

consideration  for  patient. 
"       Interview  with  husband.     Object:  Attempt  to  gain  his 
cooperation  by  agreement  to  assist  him  in  making  a  re- 
vision of  his  budget. 
10/10  Interview  with  patient.     Advice  and  encouragement. 

"       Interview  with  patient's  mother.     Reassurance. 
10/17  Conference  with  entire  family.    Aims: 

1.  To   straighten  out  difficulties   in  misunderstanding 
over  family  finances. 

2.  To  give  constructive  advice  along  this  line. 

3.  To  prompt  a  more  friendly  family  relationship. 

4.  To  have  all  sides  of  the  question  presented  impar- 
tially and  thrashed  out. 

5.  To  persuade   that   reconstructive   measures   should 
"let  bygones  be  bygones." 

6.  To  encourage  patient  by  suggestion  of  lip-reading. 
**       Dr.  Basch  interviewed  to  enlist  cooperation  and  acquire 

possible  evidence. 
10/22  Conference  at  Horace  Mann  School  to  enlist  interest  of 

teachers  and  lay  constructive  plans  for  lip-reading. 
11/  4  Patient  and  husband  interviewed.    Aims: 

1.  Financial  advice  given. 

2.  A   dietary   manual   given  patient  to   stimulate  her 
interest  and  enlist  her  cooperation  in  plan. 

3.  General  advice  and  encouragement. 

11/10  Patient  and  mother  interviewed.  Advice  and  encourage- 
ment. 

11/15  Patient  and  mother  interviewed.  Encouragement,  ad- 
vice, and  reassurance. 

11/22  Letter.     Advice  and  encouragement. 

11/25  Interview  with  patient  and  mother.     Much  reassurance. 

11/30  Patient  interviewed.     Aims: 

1.  To  make  plain  continued  friendliness. 

2.  To  encourage  and  advise. 

3.  To  give  patient  relief  of   fully  expressing  herself. 


THE    KINGDOM    OF    EVILS  lOI 

12/13  Letter.     Encouragement. 

12/14  Mother  and  stepmother  seen  in  New  York.  Object:  To 
secure  cooperation. 

12/23  Christmas  gifts  to  the  family. 

12/28  Letter  thanking  patient  for  Christmas  gifts.  Encourage- 
ment, 

1918 

1/16  Letter.     Education. 

1/17  Talked  with  husband.     Cooperation. 

1/24  Lip-reading  teacher  talked  with.     Education. 

1/25  Telephoned.     Education. 

1/26  Family  seen  at  home.     Advice,  encouragement,  coopera- 
tion, education  for  children,  reassurance  about  treatment. 

1/29  Letter  urging  treatment. 

2/  4  Same. 

2/  9  Same. 

Letter  to  husband  urging  treatment. 

2/12  Telephoned  (same  as  above). 

2/13  Patient  at  hospital.     Received  treatment. 
Patient  on  wards.     Encouragement. 
Telephoned  husband.     Education. 

2/15  Husband  seen.     Cooperation. 

2/16  Son,  William,  seen.     Education  of  William  in  attitude 
toward  patient. 

2/18  Mother  written  to.     Reassurance. 
Letter ;  arrangements  for  meeting. 
"       Mother  written  to.     Arrangements  for  starting  patient 
on  trip  to  New  York. 

2/19  Letter  to  husband  urging  generosity  toward  patient. 

2/20  Patient  taken   to   South   Station   and  put  on   train   for 
New  York.    Reassurance. 

3/1 1  Letter  to  patient.     Object:    To  give  her  courage  to  tell 
husband  that  she  had  lost  her  money. 
"       Daughter  taken  to   Dental   Infirmary   for  dental  treat- 
ment. 

3/21  Telephoned  to  get  patient  to  hospital  for  treatment. 

4/  3  Letter  urging  treatment. 

4/10  Same. 

4/24  Same. 

4/29  Letter  preparatory  to  visit. 

5/  2  Interview  with  patient  and  mother.     Advice,  encourage- 
ment, education. 

5/  8  Letter  to  husband  urging  that  William  report  at  out- 
patient department  and  that  patient  come  for  treatment. 


I02  THE    KINGDOM    OF    EVILS 

5/14  Letter  to  patient  urging  treatment. 

5/18  Patient  and  mother  interviewed  at  hospital.     Patient  is 

finally   persuaded   to   take   treatment.      Encouragement. 

Reassurance. 

Let  us  call  attention  especially  to  the  notes  in  the  above 
abstract  under  October  17;  namely,  those  that  deal  with  the 
conference  held  with  the  entire  family.  That  conference  seemed 
to  straighten  out  a  great  many  of  the  tangles.  A  very  difficult 
situation,  the  social  care  has  now  pretty  well  succeeded  in  all 
respects,  except  in  securing  proper  continuous  treatment  of  Mrs. 
Hersey's  syphilis. 

The  reliance  of  patients  upon  the  professional  character  of 
the  social  worker  irrespective  of  her  maturity  or  personal  ex- 
perience was  illustrated  well  in  this  case.  The  first  worker 
after  several  months  of  work  with  the  Hersey  family  left  the 
department  and  the  case  fell  to  a  young  woman  out  of  college 
but  a  few  years.  The  complications  of  marital  discord  with  a 
sex-delinquent  husband  might  have  caused  the  assignment  of 
the  case  to  a  more  mature  worker,  if  there  had  been  a  trained 
and  mature  worker  free  to  take  it.  The  result,  however,  jus- 
tified our  faith  in  the  ability  of  young  women  well  trained  to 
deal  with  situations  of  even  such  deep-seated  complexity  as 
Mrs.  Hersey's.  At  one  point  Mrs.  Hersey  wrote  the  young 
worker  as  follows  : — 

"You  phoned  Mr.  Hersey  last  week — it  had  some  effect,  but 
soon  wore  off,  when  he  heard  yovi  had  not  been  here.  I  do  not 
like  to  Imrden  a  young  girl  like  you  with  my  troubles  but  you 
seem  to  know  how  to  treat  such  affairs." 

In  analyzing  this  case  for  its  distribution  of  difficulties,  we 
have  tried  to  make  it  a  paradigm  in  the  threefold  group.  There 
is  no  economic  disability  of  importance.  There  is,  in  the  patient 
herself,  no  complication  worthy  of  the  term  "legal  entangle- 
ment." Of  course,  the  characters  of  the  husband  and  son 
must  be  taken  into  account;  these  are  doubtless  also,  in  some 
ways,  psychopathic  and  may  lead  to  important  legal  complica- 
tions, even  to  separation  or  divorce.  Yet  all  the  complications, 
aside  from  purely  family  ones,  converge  upon  Mrs.  Hersey's 
sheaf  of  diseases :  namely,  syphilis,  deafness,  suspiciousness, 
and  hallucinations.  In  addition  to  these  we  found  her  some- 
what deficient  in  general  judgment  and  of  a  certain  extrava- 


THE    KINGDOM    OF    EVILS  IO3 

gance  in  managing  her  household,  but  these  deficiencies  were 
such  as  to  be  rather  corrigible  by  training.  It  would  be  rather 
difficult  to  draw  the  line  in  this  counsel  between  a  belated  edu- 
cation, true  moral  training,  and  psychotherapy  itself.  So  deaf 
a  person  should,  long  since,  have  been  taught  lip-reading,  and 
her  deficiency  therein  must  be  mentioned  as  one  of  Mrs.  Ker- 
sey's educational  disabilities.  As  will  be  noted  from  the  above 
extract  of  the  treatment  records,  steps  were  taken  to  teach  her 
lip-reading.  She  was  something  of  a  moral  problem  for  us,  in- 
asmuch as  she  seemed  not  to  have  the  will  to  stand  to  her  treat- 
ments persistently.  Moreover  she  had  been  a  nagging  sort  of 
wife. 

On  these  scores  we  have  made  her  a  paradigm  of  medical, 
educational,  and  moral  deficiency,  but  we  regard  her  social 
problem  as  centering  in  her  diseases. 

Hours  spent  by  Medical  record,  35  pages 

Social  record,  35  pages 
Physician,  io}i  Social  work: 

Visits,  15 
Psychologist,  o  Interviews  at  hospital,  24 

Telephone  calls,  13 
Social  worker,  53^  Letters,  45 


^'Mystery  girl"  of  the  newspapers.  Sleeping  spells  on  the 
street.    Feeble-minded,  hysterical. 

Case  15.  Bessie  Polski  figured  in  the  newspapers  as  a 
"mystery  girl."  The  police  officer  found  the  nineteen-year-old 
Polish  girl  in  a  faint  and  brought  her  to  the  Associated  Char- 
ities. Bessie  said  that  she  had  been  going  to  commit  suicide. 
She  had  a  letter  which  reads  as  follows  : — 

"I  am  awfly  sorry,  and  am  a  Catholic  girl,  and  know  that  I 
will  lose  my  heart,  but  I  cant  help  it  because  I  am  so  hungry 
that  I  dont  know  what  to  do.  I'm  afraid  to  take  poison  but  I 
cant  help  it  because  I  cant  live.  I  cant  give  another  to  my 
cousin  because  he  said  I  am  not  his  cousin  [untrue].  I  have 
not  one  cent  and  no  money  and  I  dont  know  how  to  live.  I  dont 
know  where  to  go,  and  the  next  day  I  did  not  eat  nothing  for 
the  whole  day.  I  am  a  young  girl,  I  dont  eat  nothing,  only  cry 
all  the  time.     I  have  hurt  my  hand  and  didn't  work  for  five 


I04  THE    KINGDOM    OF    EVILS 

weeks.     Pleas  who  will  help  me.     I  am  so  poor  that  I  sleep  on 
the  street,  no  one  knows  me,  and  I  don't  eat  at  all." 

The  statement  about  her  cousin  has  been  noted  above  as 
untrue  and  a  variety  of  other  statements  failed  to  hold  water. 
The  day  after  the  police  found  her  she  was  brought  to  the  Psy- 
chopathic Hospital  and  there  was  determined  to  be  not  insane 
(that  is,  in  the  medico-legal  sense  of  not  being  committable  to 
some  receptacle  for  the  insane)  but  to  be  hysterical.  Bessie 
said  that  she  was  subject  to  long  attacks  of  unconsciousness. 
Her  "sleeping  periods"  lasted  from  a  few  hours  to  ten  days, 
with  convulsive  attacks  of  laughing  and  crying  and  a  localized 
anesthesia  of  the  skin  of  the  neck.  Early  in  her  stay  at  the 
hospital  she  apparently  had  another  psychopathic  sleeping  spell 
which  lasted  about  a  day. 

She  now  went  from  the  hospital  into  the  care  of  an  agency, 
which  agency  tried  to  have  her  go  to  a  state  institution  for 
treatment  of  syphilis,  which  she  was  supposed  to  have  con- 
tracted (the  blood  serum  reaction  was  positive  according  to 
the  Wassermann  test,  and  there  was  a  slight,  though  distinct, 
evidence  of  inflammatory  reaction,  if  we  are  to  trust  the  cell 
count  in  the  spinal  fluid  ) .  Whether  these  findings  indicate  the 
acquisition  of  syphilis  by  this  girl,  or  whether  they  possibly 
indicate  that  she  was  a  victim  of  congenital  syphilis  (victims 
of  congenital  syphilis  are  not  infrequently  without  any  labora- 
tory sign  whatever  of  their  syphilis)  must  be  left  in  doubt.  In 
any  event,  Bessie  did  not  reach  the  state  institution  and  further 
blood  specimens  proved  negative  to  syphilis  two  months  and  a 
half  later. 

She  went  back  home,  and  the  case  dropped  out  of  social 
service  contacts  for  about  two  months,  when  a  rather  extraor- 
dinary episode  took  place.  ^Vhile  Bessie  was  going  along 
the  street,  she  was  accosted  by  a  man,  to  whom  she  said  she 
was  looking  for  work.  The  man  said  that  she  might  go  with 
him  to  a  tenement  house  to  meet  his  brother,  the  foreman  of 
a  candy  factory  who  would  get  work  for  her.  What  happened 
in  the  tenement  house  was  rape  by  three  men.  Bessie's  outcries 
drew  the  police.  The  men  escaped.  The  girl  was  held  as 
witness. 

Some  convulsions  shortly  ensued  and  Bessie  was  brought 
once  more  to  the  Psychopathic  Hospital,  whence  she  was  dis- 


THE    KINGDOM    OF    EVILS  IO5 

charged,  ten  clays  later,  with  the  same  diagnosis  as  before, 
hysteria.  She  was  observed  in  a  so-called  convulsion  while  in 
the  hospital.  The  seizure  lasted  three  minutes,  during  which 
she  got  red  and  gritted  her  teeth.  She  did  not  bite  her  tongue 
or  froth  at  the  mouth.  Her  attacks  would  in  general  begin 
with  a  feeling  of  pressure  in  the  chest  and  a  palpitation  of  the 
heart;  then  there  would  be  a  choking  sensation  in  the  throat, 
whereupon,  apparently,  unconsciousness  would  supervene,  for 
the  patient  could  not  describe  the  rest  of  the  attack  during 
which  she  would  laugh,  cry,  and  toss  her  arms  about.  Curi- 
ously enough,  the  loss  of  sensation  observed  upon  her  first 
visit  to  the  hospital  was  not  now  at  all  in  evidence. 

She  went  out  to  live  at  home,  had  an  operation  for  appendi- 
citis, and  did  not  come  under  observation  again  until  four 
months  later.  Then  came  the  following  newspaper  clipping 
which  may  serve  to  show  the  attitude  of  newspaper  men  to  the 
so-called  "mystery  girl." 

"girl  defies  doctors'  efforts  to  waken  her 

"Going  to  Sleep  for  Long  Periods  Has  Become  Habit  with 
Bessie  Polski. 

"Bessie  Polski,  who  goes  to  sleep  for  periods  that  vary  from 

a  few  days  to  several  weeks,  is  at  the  Hospital  in  sound 

slumber  and  puzzling  the  doctors.  She  lies  in  bed  calmly,  with 
her  eyes  wide  open,  and  takes  food  when  it  is  offered,  but 
seems  unconscious. 

"About  a  year  ago  she  had  another  long  sleep  at  her  home 

in  ,  and  was  in  a  far  more  serious  condition,  as  she  was 

unable  to  take  food,  and  had  to  be  fed  through  the  nose.     Dr. 

of   who    attended   her   at   that   time,    thought    she 

was  suffering  from  a  form  of  hysteria.  Her  history,  he  says, 
shows  a  similar  sleep  of  several  weeks'  duration  when  she  was 
living  in . 

"She  went  to  sleep  on  the  sidewalk  at  Park  and  Madison 
Streets  and  was  taken  to  a  drug  store,  where  attempts  were 
made  to  revive  her.  Later  she  was  taken  to  the  hospital,  where 
one  of  the  nurses  [sic]  remembered  that  she  was  brought  to 
the  hospital  several  months  ago  in  similar  circumstances.  At 
that  time  she  was  asleep  for  the  greater  part  of  five  days. 

"It  is  said  that  she  has  met  with  several  accidents  in  places 
where  she  was  emploved,  and  that  about  two  weeks  ago  she  fell 
from  a  car  at Street." 


I06  THE    KINGDOM    OF    EVILS 

She  was  again  observed  at  the  Psychopathic  Hospital,  but 
had  no  longer  any  seizures  and  showed  no  further  sleeping 
periods.  There  were  no  stigmata  of  hysteria.  It  was,  how- 
ever, decided  that  she  might  best  be  committed  to  a  state  hos- 
pital. The  basis  for  such  commitment  was,  not  so  much  the 
hysteria,  as  the  feeble-mindedness  which  she  showed  upon  psy- 
chological examination.  There  were  no  marked  irregularities 
in  this  examination,  which  gave  her  a  Point  Scale  age  of  nine 
years,  actual  age  nineteen  years.  Her  attention  was  unstable 
and  she  was  oversuggestible  by  the  tests  employed.  In  other 
respects  she  was  rather  generally  deficient. 

After  a  time  she  was  released  from  the  state  hospital  and 
placed  out,  but  she  could  make  very  poor  wages  and  was  even- 
tually allowed  to  go  back  to  her  family  whom  she  aided  by 
working  in  a  restaurant.  At  last  accounts  she  was  earning  a 
little  money  by  working  in  a  restaurant. 

This  case  we  present  as  a  paradigm  of  triple  disorder,  medi- 
cal, educational,  and  legal.  The  medical  fraction  of  the  count 
is  clear :  the  two  years'  history  of  hysteria  and  the  low  mental 
capacity,  not  necessarily  in  alliance  with  one  another  in  all 
cases,  are  no  doubt  combined  in  Bessie  Polski  to  confuse  results 
of  social  treatment  and  to  complicate  the  economic  situation. 
The  educational  deficiency  was  a  marked  one,  centering  chiefly 
upon  a  language  difficulty,  which  was  not  merely  the  girl's  own 
but  was  shared  by  all  her  relatives.  A  galaxy  of  Polish- 
speaking  social  workers  might  have  been  necessary  to  have 
made  all  the  points  desirable  with  Bessie's  relatives.  The 
legal  complications  with  the  police  by  reason  of  the  rape  at- 
tempts were  dominant.  It  is  perhaps  well  to  say  that  not  all 
the  "mystery  girls"  who  form  so  striking,  if  so  small,  a  part 
of  the  psychopathic  hospital  clinic  are  feeble-minded.  It  might 
be  inquired  whether  this  girl,  a  probable  victim  of  rape,  a  pos- 
sible sex  delinquent  prior  to  her  first  period  of  observation  at 
the  Psychopathic  Hospital,  should  not  be  considered  as  some- 
what of  a  moral  problem.  Our  evidence  is,  however,  that  she 
was,  in  general,  not  immoral  in  the  popular  sense  of  this  term. 
We  are  not  even  sure  that  syphilis  was  ever  acquired.  In  any 
event  the  problem  of  social  care  did  not  seem  at  any  time  to 
involve  moral  training.  Bessie's  "immorality,"  if  such  we  may 
call  it,  was  no  doubt  a  matter  of  ignorance,  and  the  total  prob- 
lem here  was  one  of  adjustment  to  the  community,  with  due 


THE    KINGDOM    OF    EVILS  IO7 

regard  to  the  feeble-mindedness  and  hysteria  on  the  one  side, 
and  the  language  difficuhy  and  educational  deficiency  on  the 
other. 

There  was  no  proper  guardian  for  Bessie  save  the  public 
institution  from  whose  iron  she  might  be  saved  by  the  velvet 
glove  of  social  service.  The  only  relative  of  this  girl  in  this 
country  was  a  well-meaning,  friendly,  but  ignorant  cousin, 
whose  wife  could,  of  course,  not  understand  Bessie's  feeble- 
mindedness, to  say  nothing  of  her  hysteria,  and  assumed  a 
rather  hostile  attitude  to  her.  The  proper  answer  to  the  Bessie 
Polski  question  was  evident  resort  from  time  to  time  to  a  pub- 
lic institution.  Obviously  we  cannot  count  this  case  as  one  of 
highly  successful  social  practice,  yet  it  is  as  well  to  demonstrate 
failures  and  negative  results  from  time  to  time  as  always  to 
put  the  very  best  foot  forward.  We  above  spoke  of  the  desir- 
ability of  public  institutional  care ;  but  it  is  worth  further  speci- 
fying that  the  public  institution  in  question  should  uncondi- 
tionally be  a  medical  institution  and  not  of  the  prison  system. 
The  chief  social  service  contribution  in  the  case  of  Bessie  Pol- 
ski,  then,  may  be  summed  up  in  the  words  "public  care  and 
supervision  under  medical  auspices." 

Hours  spent  by  Medical  record,  34  pages 

Social  record,  8  pages 
Physician,  9  Social  work  : 

Visits,  6 
Psychologist,  I  Interviews  at  hospital,  3 

Telephone  calls,  3 
Social  worker,  11  Letters,  10 


Grown-up  "spoiled  child."    A  motherly  landlady  found. 

Case  16.  Mark  White  is  now  nearing  thirty-one  years, 
but  strikes  one  still  as  a  rather  overgrown  boy.  He  is  rather 
an  inferior-looking  shipping  clerk,  who  came  of  his  own  initia- 
tive to  the  Psychopathic  Hospital.  He  said  he  was  afraid  of 
crowds  and  that  his  memory  was  not  as  good  as  it  had  been. 
He  dated  his  troubles  from  a  time  when  his  express  wagon 
had  run  into  a  street  car  and  stunned  him.  Pie  had  a  darnage 
suit  brought  after  this  accident.  He  told  of  hallucinations  of 
several  sorts,  the  absurdity  of  which  he  said  he  now  realized. 


Io8  THE    KINGDOM    OF    EVILS 

Once  he  had  thought  a  doctor  had  hypnotized  him.  He  had 
very  pecuhar  ideas  about  masturbation,  which  he  said  that  he 
had  done  as  a  rebel  against  God  and  to  displease  God.  The 
patient  was  a  Roman  Catholic.  We  found  him  to  grade  at  16.5 
years  on  the  Point  Scale  and  to  show  few  failures  except  in  the 
memory  tests;  but  in  his  memory  he  was  more  erratic  than 
actually  deficient.  The  question  was  raised  whether  he  might 
be  a  psychoneurotic,  or  possibly  a  victim  of  dementia  praecox. 

A  study  of  his  family  relations  showed  that  he  had  been  for 
many  years  rather  ext'"aordinarily  dependent  upon  his  doting 
mother's  care;  but  she  had  died  four  months  before  he  came 
to  us.  Up  to  this  time  he  had  been  thrown  only  in  the  society 
of  women  of  his  mother's  age  and  had  made  no  friends  amongst 
his  own  sex  or  amongst  younger  women.  He  was  a  sort  of 
overgrown,  spoiled  child,  a  rather  seclusive  and  very  self -accusa- 
tory person.  As  for  the  hallucinations  above  mentioned,  it  is 
a  question  how  gravely  they  are  to  be  taken  in  the  matter  of 
the  diagnosis  of  schizophrenia  ( dementia  praecox).  Certainly 
the  notions  about  hypnotism  and  about  masturbation  are 
peculiar  enough  to  suggest  schizophrenia,  and  the  so-called 
ideas  of  reference  (people  pursuing  him  on  the  street)  might 
be  used  in  building  up  that  diagnosis. 

He  was  discharged  to  the  social  service  without  a  definitive 
diagnosis  between  schizophrenia  and  psychoneurosis.  The 
ideal  in  such  a  case  as  that  of  Mark  White  might  be  to  give 
him,  in  a  popular  phrase,  some  sort  of  "sublimation."  The 
best  social  service  could  do  appears  to  have  been  to  give  him 
compensation.  A  landlady  of  maternal  type  was  secured 
through  a  room  registry.  Upon  due  explanation  of  Mark's 
plight,  the  landlady  undertook  his  care.  A  position  was  found. 
The  end  crowned  the  landlady's  work.  Mark  is  now  at  least  as 
well  off  as  ever,  perhaps  better.  Latterly  he  has  even  developed 
some  fresh  contiguities  and  interest  in  women  of  his  own  age. 
He  became  particularly  interested  in  the  nurse  who  took  him 
through  influenza.  Formerly  made  fun  of  where  he  worked, 
he  has  now  become  well  liked  and  sociable  both  with  men  and 
women  of  his  own  age.  The  socializing  problem  is  going 
apace  with  the  aid  of  church  measures,  the  community  chorus 
and  the  like.  Aside  from  irritabilities  at  the  doctors,  Mark 
White  seems  to  be  approximating  the  normal. 

Briefly  analyzed,  Mark  White  appears  to  be  a  threefold  case 


THE    KINGDOM    OF    EVILS  IO9 

of  social  difficulty  in  which  neither  moral  nor  legal  difficulties 
appear.  His  medical  category  must  remain  in  doubt ;  but  there 
can  be  no  doubt  that  he  is  in  some  sense  psychopathic.  His 
curious  up-bringing  and  maternal  spoiling  form  an  equally 
prominent  part  of  the  story;  indeed  some  might  claim  that  the 
medical  difficulty  traced  absolutely  and  entirely  back  to  his 
curious  home  environment.  He  was  economically  in  the  need 
of  aid  during  the  first  months  of  observation,  coming  to  us  as 
an  object  of  charity,  with  the  history  of  being  in  debt  and  of 
having  received  aid  from  a  relief  society. 

Hours  spent  by  Medical  record,  42  pages 

Social  record,  38  pages 
Physician,   9^  Social  work  : 

Visits,   26 
Psychologist,  i  Interviews  at  hospital,  13 

Telephone  calls,  55 
Social  worker,  57^  Letters,  25 


Alcoholic  and  syphilitic  woman  under  the  influence  of  di- 
vorced delinquent  husband.  Refused  treatment.  Ahoulia 
( weak-willedness  ) . 

Case  17.  Eva  Collins,  a  sales  clerk,  thirty-one  years  old. 
is  presented  to  illustrate  the  threefold  combination  of  social 
difficulties :  medical,  moral,  and  legal — the  educational  and 
economic  elements  being  absent  or  negligible.  The  prime  medi- 
cal reasons  for  her  hospital  observation  were  alcoholism  and 
neurosyphilis.  Indeed,  her  first  diagnosis  was  that  of  locomo- 
tor ataxia  (now  universally  recognized  to  be  a  syphilitic  dis- 
ease) and  a  "psychotic  episode"  due  to  alcohol.  Mrs.  Collins 
had  acquired  her  syphilis  from  a  sex  delinquent  and  otherwise 
criminal  (forger)  husband,  whom  she  had  married  twelve  years 
before  our  observation  of  her,  namely  at  the  age  of  nineteen. 
It  is  probable  that  we  must  regard  her  as  a  rather  indecisive 
and  weak-willed  person,  and  this  native  hypoboulia  was  at  last 
to  interfere  gravely  with  her  fate.  She  was  for  various  medi- 
cal reasons  regarded  as  a  most  promising  case  for  antisyphilitic 
treatment;  but,  owing  to  her  indecisiveness  of  character  and  to 
a  more  or  less  ill-grounded  desire  to  get  away  from  the  Psycho- 


no  THE    KINGDOM    OF    EVILS 

pathic  Hospital  atmosphere  and  sundry  drawbacks  of  its  pub- 
licity, she  continued  for  but  ten  months  under  our  social  care 
and  medical  treatment.  Despite  continual  efforts  our  contacts 
with  her  grew  fewer  and  fewer  during  the  last  few  months 
before  her  case  was  closed  on  the  score  of  her  recalcitrance. 

It  is  interesting  to  note  that  a  poorer  patient  who  could  not 
have  begun  to  pay  for  antisyphilitic  treatment  would  doubtless 
have  remained  under  our  care  despite  objections  on  her  part 
to  being  hospitalized. 

Doubtless  under  ideal  conditions  of  social  work,  recalcitrant 
cases  of  this  sort  would  be  pertinaciously  pursued  into  the  com- 
munity so  far  as  the  rights  of  privacy  of  the  individual  would 
permit.  Relative  to  these  selfsame  rights  of  privacy,  it  is  of 
course  a  modern  point  of  view  that  syphilitics  of  whatever  sort 
are  hardly  entitled  to  so  much  privacy  as  that  which  normal 
persons  enjoy.  The  house  of  a  syphilitic  is  not  his  castle. 
Moreover,  we  have  to  deal  with  a  delinquent  and  vicious  hus- 
band. It  has  for  years  been  plain  that  only  the  very  poor  and 
very  rich  get  adequate  medical  treatment.  Here  Mrs.  Collins 
offers  a  peculiar  instance  of  failure  on  the  part  of  the  moder- 
ately well-to-do  person  to  get  continued  treatment  from  a  mix- 
ture of  pride  motives,  indecision  of  character,  and  husband's 
influence. 

Mrs.  Collins  felt  that  she  was  well-to-do  enough  to  employ 
a  private  physician,  and  this  was  no  doubt  the  case,  but  in  our 
experience  the  proper  tenacity  of  antisyphilitic  treatment  is 
rarely  shown  in  private  practice  partly  for  reasons  grounded 
in  the  old-time  attitude  of  physicians  to  the  syphilis  problem 
and  partly  because  a  patient  without  marked  symptoms  slackens 
his  interest  in  treatments  that  are  on  the  whole  rather  annoying. 

We  have  noted  that  the  difficulties  of  moral  adjustment 
here  were  perhaps  grounded  in  a  degree  of  psychopathic  inde- 
cision and  perhaps  also  in  part  in  the  neurosyphilis  itself. 
There  were  also  sundry  divorce  complications.  When  Mrs. 
Collins  first  reached  the  hospital,  she  was  endeavoring  to  secure 
a  divorce.  Although  she  was  prevailed  upon  to  abstain  from 
her  husband's  company  for  a  period  of  six  months  and  although 
the  divorce  proceedings  were  carried  through,  she  reversed  her 
attitude  shortly  and  began  to  get  her  alimony  at  the  personal 
hand  of  her  former  husband.    How  intimate  her  relations  with 


THE    KINGDOM    OF    EVILS  III 

the  former  husband  now  became  is  ar  matter  of  doubt.  Before 
we  lost  track  of  her,  however,  she  had  lost  contact  with  her 
former  husband  and  announced  to  us  that  she  was  now  keeping 
company  with  another  man,  to  whom  she  said  she  was  to  be 
married.  Permanent  loyalty  to  husband,  relatives,  physicians, 
or  hospitals  was  apparently  inconsistent  with  Mrs.  Collins'  char- 
acter. These  shifts  in  allegiance  were  regarded  as  probably 
part  and  parcel  of  the  weak-willedness  (aboulia)  noted  through- 
out, but  it  may  be  that  there  is  a  slight  general  tendency  in 
Mrs.  Collins  of  the  sort  sometimes  termed  paranoic,  a  tendency, 
that  is  to  say,  to  the  development  of  delusions  of  persecution. 
She  was  rather  childlike  in  her  attitude  to  ordinary  affairs 
such  as  her  money.  After  she  was  in  straits  about  money,  she 
fell  into  a  sort  of  depression  and  thence  into  alcoholism.  She 
drank  with  her  husband.  This  lapse  into  drinking  became  in- 
grained and  what  might  be  called  a  conditioned  reflex  upon 
seeing  her  husband.     Seeing  him  would  precipitate  a  bout. 

We  have  not  up  to  this  time  mentioned  the  hereditary  taint 
in  Mrs.  Collins;  but  when  we  put  together  the  medical  and 
moral  features  of  her  case,  we  are  not  unprepared  to  find  that 
her  mother  and  a  sister  had  actually  been  committed  cases  to  an 
institution  for  the  chronic  insane.  The  mother  had  suffered 
from  involution  melancholia  and  the  sister  from  dementia  prae- 
cox.  Other  brothers  and  sisters  were  normal  enough.  We 
have  spoken  of  her  as  childlike  in  worldly  reactions,  yet  she 
made  an  exceedingly  high  score  upon  her  psychometric  test, 
namely  i8-\-',  with  a  score  of  93  points  on  the  Point  Scale. 
The  only  item  of  her  psychometric  record  at  all  noteworthy 
was  a  certain  degree  of  oversuggestibility.  How  far  "over- 
suggestibility"  of  routine  psychometric  tests  can  be  correlated 
with  Vv^eak-willedness  (aboulia)  remains  doubtful,  and  it  is  a 
stock  and  justified  complaint  that  routine  psychological  tests 
have  so  far  not  quite  measured  up  to  our  hopes  of  definite 
means  of  judgment  concerning  moral  capacities  and  poten- 
tialities. 

To  justify  our  calling  this  case  a  combination  not  only  of 
medical  and  moral  troubles  but  of  serious  legal  ones,  we  need 
refer  only  to  the  divorce  complication.  As  a  sample  of  record 
of  social  treatment  we  insert  the  following  entries  for  three 
months : — 


112  THE    KINGDOM    OF   EVILS 

I917  .     .  .        ,  .. 

8/30  Interview  for  purpose  of  enlisting  patient's  cooperation 

for  future  treatment  by  appealing  to  her  intelligence 
and  for  purpose  of  bracing  her  up  to  point  of  decision  of 
living  away  from  husband.  Friendliness  of  patient 
clinched  by  offer  of  visit  to  mother  with  view  of  arrang- 
ing her  treatment  at  home  and  incidentally  gaining  access 
in  natural  manner  to  patient's  relatives. 

8/31  Purpose  of  visit  to  patient's  mother  carried  out.  Family 
cooperation  enlisted  largely  through  offer  of  medical 
assistance  to  mother.  Investigation  made  easy  through 
this  method. 

9/  5  Letter   to  patient  to   show  continued    friendly   interest. 

9/  6  Encouragement  of  patient  continued. 

9/  8  Patient's  confidence  strengthened  by  friendly  advice 
which  leads  naturally  to  frank  discussion  on  the  subject 
of  patient's  use  of  alcoholics. 

9/1 1  Lawyer  interviewed  for  purpose  of  establishing  good 
working  cooperation  with  him  and  with  idea  of  clearing 
his  mind  of  any  misapprehensions  in  regard  to  social 
service  connection  with  case.  Cooperation  secured  and 
constructive  plan  leading  toward  future  change  of  work 
outlined. 

9/12  Encouragement. 

9/18  Evening  call  on  patient  for  purpose  of  showing  social 
friendliness  as  well  as  for  purpose  of  sizing  up  patient's 
living  conditions. 

9/21  Visit  to  Mrs.  Smith  (an  acquaintance  of  visitor)  in  hope 
of  connecting  her  up  with  patient  on  friendly  basis. 

9/25  Letter  to  lawyer  for  purpose  of  keeping  him  informed 
in  regard  to  social  service  interest. 

9/29  Encouragement. 

10/  I  Encouragement  and  advice  in  regard  to  patient's  family 
situation  which  is  reacting  upon  patient. 

10/15  Business  course  started  according  to  plan  of  9/1 1. 

10/18  Encouragement. 

10/20  Arrangement  made  for  outside  examination  of  patient 
by  oculist  in  order  to  save  working  time  and  make  exam- 
ination as  little  of  a  nervous  strain  as  possible  to  patient. 

10/22  Encouragement  and  advice. 


THE    KINGDOM    OF    EVILS  1 13 

10/29  Call  to  show  friendly  interest. 

11/  3  Encouragement  and  reassurance  in  regard  to  situation  in 
family  of  patient's  sister. 

11/12  Call  for  purpose  of  friendly  advice  and  encouragement. 

11/21  Conference  with  Visiting  Nursing  Association  in  order 
to  gain  their  cooperation  through  explanation  of  mother's 
eccentricities. 

11/23  Visit  to  patient's  sister  for  purpose  of  getting  over  to  her 
the  fact  that  there  is  an  intelligent  and  constructive  treat- 
ment possible  to  use  in  the  case  of  a  boy  of  the  make-up 
of  her  son.  Patient  reassured  by  this  interview  and  co- 
operation of  sister  gained  in  making  better  plan  for  her 
nephew.  Opportunity  taken  to  straighten  out  situation 
existing  between  district  nurse  and  mother. 

11/27  Arrangements  made  with  Dr.  Jones  in  order  to  insure 
interest  and  reliable  medical  advice  for  patient's  nephew, 
on  which  to  base  future  social  action. 

Hours  spent,  by  Medical  record,  30  pages 

Social  record,  2)1  pages 
Physician,  4  Social  work  : 

Visits,  27 
Psychologist,  i  Interviews  at  hospital,  16 

Telephone  calls,  30 
Social  worker,  46^  Letters,  25 


Psychasthenic  atmosphere  about  an  eye  trouble.  Alcoholic, 
spoiled  child. 

Case  18,  Hamilton  Green,  a  rather  under-sized,  boyish- 
looking  man  of  twenty-nine,  came  voluntarily  to  the  Psycho- 
pathic Hospital  at  the  suggestion  of  the  social  service  of  a  gen- 
eral hospital.  It  was  plain  that  he  was  in  some  important  diffi- 
cult way  an  "eye  case,"  but  the  medical  story  would  sound  a 
good  deal  more  complex  if  one  took  into  account  the  indigestion, 
constipation,  headache,  dizziness,  nervousness,  fearfulness  on 
the  street,  whisperings  heard  when  going  to  sleep,  temporary 
drinking  to  excess,  "gas  on  the  heart,"  and  the  like.  Compe- 
tent ophthalmological  examination  showed  the  man,  who  had 
recently  been  a  porter  and  elevator  boy,  to  have  an  actually 
severe  astigmatism,  such  that  exceedingly  strong  lenses  were 


114  "^^^    KINGDOM    OF    EVILS 

required.  There  was  no  small  degree  of  hereditary  taint; 
namely,  a  question  of  mental  or  nervous  disease  in  the  father, 
epilepsy  in  certain  paternal  cousins,  and  stammering  in  ma- 
ternal relatives. 

The  second  element  in  Green's  case  is  the  moral  one.  He 
was  at  times  excessively  alcoholic.  But  a  more  fundamental 
moral  deficiency  lay  in  his  irresponsibility  to  his  mother.  Per- 
haps this  is  to  be  laid  in  part  to  his  being  a  spoiled  child.  He 
was  an  only  child.  His  mother  helped  him  financially.  Other 
relatives  helped  out  also.  Yet  applications  to  the  Associated 
Charities  were  from  time  to  time  made,  but  had  to  be  refused 
because  of  these  family  resources.  Finally,  however,  the 
mother  ran  through  the  small  capital  sunk  in  their  house  and 
mother  and  son  became  partial  public  charges.  That  there  was 
a  necessity,  therefore,  in  Green's  mental  or  medical  condition 
is  not  likely.  There  was  a  question  of  moral  attitude  involved. 
This  moral  deficiency  has  now  been  in  part  made  up  through 
the  counsels  and  insistence  of  the  social  workers.  At  this  time 
it  is  fair  to  say  that  Green's  own  interior  ambition  has  been 
aroused  so  that  the  social  service  splint  may  not  for  all  time 
be  necessary  for  him. 

As  for  the  economic  deficiency,  we  have  discussed  it  in  gen- 
eral terms  in  the  above  paragraphs.  After  some  two  months  of 
handling  by  the  social  service,  no  further  grants  of  money  were 
required  for  Green. 

The  situation  now  shows  in  the  foreground  the  eye  trouble, 
which  is  not  only  objectively  somewhat  serious,  but  has  shown 
no  signs  of  disappearing  as  an  object  of  careful  subjective  con- 
cern. Green  continually  complains  of  the  drawing  of  his 
glasses,  of  his  not  desiring  to  walk  up  a  hill  for  fear  of  its 
rising  to  strike  him,  of  his  often  misjudging  distances,  and  so 
on.  However,  he  has  been  prevailed  upon  to  stick  closely  to  a 
single  eye  clinic,  and  no  doubt  in  the  long  run  the  subjective  con- 
cerns, which  now  seem  almost  obsessive,  will  atrophy  or  gradu- 
ally retire.  Here  we  have  an  example  of  what  is  sometimes 
termed  a  "periorganic"  situation.  The  term  periorganic  refers 
to  the  actual  objective  existence  of  a  serious  somatic  trouble 
(in  this  instance  astigmatism)  around  which  develop  by  almost 
natural  processes  an  obsessive  or  a  psychasthenic  atmosphere. 
Reference  to  the  first  paragraph  of  our  discussion  gives  a  cata- 
logue of  complaints  forming  this  psychasthenic  atmosphere. 


THE    KINGDOM    OF    EVILS  II 5 

Remarkable  therein  are  the  actual  hallucinations,  the  hearing  of 
whispers  as  he  goes  to  sleep.  These  so-called  hypnagogic  hallu- 
cinations of  hearing  are  interesting  also  in  connection  with  the 
flashes  of  light  which  Green  says  he  imagined  after  he  had 
been  dreaming  about  his  landlady,  whose  rent  was  two  months 
past  due.  Whether  these  phenomena  are  to  be  regarded  as 
genuine  hallucinations  or  as  vivid  fancies  of  a  dreamlike  world 
remains  still  in  doubt.  Some  observers  of  Green  have  thought 
of  him  as  possibly  a  victim  of  schizophrenia  (dementia  praecox) 
and  would  no  doubt  look  upon  these  hallucinations  or  pseudo- 
hallucinations  as  consistent  with  that  far  more  serious  disease, 
schizophrenia,  than  the  one  we  have  elected  to  ascribe  to  this 
man.  However  this  may  be,  practically  all  of  the  constellation 
of  symptoms  first  set  forth  has  now  vanished,  leaving  astigma- 
tism and  its  immediate  sequelae  in  the  center  of  the  stage.  We 
should  make  one  exception.  Green  will  still  occasionally  lose 
a  job  through  getting  drunk.  Green  claims  that  his  drinking 
is  somehow  connected  with  his  eye  trouble,  or  at  all  events 
that  the  drinking  habit  is  in  general  a  matter  of  the  last  five 
years  during  which  time  the  astigmatism  came  to  the  surface 
of  his  life. 

Hours  spent  by  Medical  record,  9  pages 

Social  record,  17  pages 
Physician,  5I/2  Social  work  : 

Visits,  16 
Psychologist,  0  Interviews  at  hospital,  3 

Telephone  calls,  9 
Social  worker,  28J/2  Letters,  12 


Industrial  traumatic  neurosis  in  a  competent  steady  family 
man.    Family  problem.    Slow  recovery  with  graded  light  work. 

Case  19.  John  Flynn  we  present  as  combining  medical, 
legal,  and  economic  elements  of  trouble. 

The  legal  elements  in  question  are  Industrial  Accident  Board 
complications.  Although  we  have  all  along  stressed  the  cen- 
trality  of  the  individual  in  social  psychiatric  cases,  we  have  not 
intended  to  give  the  impression  that  the  family  group  is  not 
equally  in  the  practical  eye  of  the  social  worker.  John  Flynn's 
problem  would,  no  doubt,  be  very  properly  regarded  as  a  fam.- 
ily  problem  by  the  non-psychiatric  social  workers.     The  psy- 


Il6  THE    KINGDOM    OF    EVILS 

chiatric  social  worker  regards  it  also  as  a  family  problem 
(with  even  sundry  psychiatric  complications  produced  by  the 
wife's  ignorance  or  feeble-mindedness  as  indicated  by  her 
rating  of  11.6  by  the  Point  Scale)  but  finds  the  hub  of  the  diffi- 
culty, after  all,  to  lie  in  the  psychopathic  central  figure. 

The  psychopathy  in  question  was  traumatic  neurosis.  By 
neurosis  we  mean  a  functional,  that  is,  a  theoretically  curable 
disease,  which,  under  proper  treatment,  ought  to  revert  to  the 
normality  of  the  man  before  his  accident.  (It  may  be  as  well 
to  say  that  traumatic  psychosis,  also  at  times  suspected  in  John 
Flynn,  means  a  disease  of  more  serious  character,  often  a  con- 
dition of  defect  directly  consequent  upon  brain  injury,  and 
hence,  not  to  such  a  degree  recoverable ;  and  the  rather  poor 
prognosis  early  offered  by  the  physicians  for  John  Flynn  him- 
self was  probably  due  to  the  suspicion  that,  in  addition  to  trau- 
matic neurosis,  there  might  be  some  irrecoverable  brain  defect 
in  him.  The  traumatic  neuroses  may  be  best  classified  under 
the  psychoneuroses,  though  the  traumatic  forms  of  psycho- 
neurosis  offer  rather  special  features. 

A  hundred  pound  weight  struck  a  glancing  blow  on  Flynn's 
head,  causing  a  scalp  wound.  Flynn  was  not  made  unconscious 
by  the  blow.  He  has  always  stuck  to  the  idea  that  the  weight 
hit  not  only  his  head,  but  his  back,  and  explains  the  persistence 
of  pains  in  the  head  and  back  from  that  circumstance.  Flynn 
was,  at  the  time,  in  the  midst  of  some  rather  complicated  ma- 
chinery. He  saved  liimself  by  dropping  some  thirty  or  forty 
feet  to  another  part  of  the  machinery.  He  was  able  to  work 
a  day  or  two,  but  then  had  to  give  it  up  by  reason  of  severe 
headaches  and  dizziness.  The  dizziness  passed,  and  to  some 
extent  the  headache,  but  he  could  not  work,  or  felt  that  he 
could  not  work,  on  account  of  persistent  backache.  He  did  not 
arrive  for  treatment  at  the  Psychopathic  Hospital  until  seven 
months  after  the  accident. 

Meantime  he  had  been  in  contact  with  the  Industrial  Acci- 
dent Board,  through  which  compensation  was  granted  him  at 
the  rate  of  ten  dollars  a  week,  being  six  dollars  less  than  his 
previous  earnings.     Some  small  savings  he  quickly  used  up. 

There  was  no  mauvaisc  volontc  about  Flynn.  He  wanted 
to  be  cured  and  made  several  unsuccessful  attempts  to  work. 
The  background  was  not  bad.  He  had  once  been  a  hatter, 
earning  as  much  as  twenty-four  dollars  a  week  at  one  time. 


THE    KINGDOM    CF    EVILS  11/ 

Later  he  had  become  a  machine  oiler.  He  was  interested  in 
machinery,  had  been  ambitious  enough  to  attend  evening  classes 
for  firemen,  read  and  studied  a  good  deal  and  had  saved  several 
hundred  dollars.  He  was  a  good  family  man,  amiable  in  dis- 
position, energetic,  and  strong.  Now,  since  the  accident,  he 
had  become  apathetic  and  seclusive.  He  read  no  more  and  was 
apt  to  be  irritable  when  approached.  His  sleep  was  poor.  He 
felt  tremblings  all  over  his  body  and  felt  sometimes  as  if  his 
legs  were  going  out  from  under  him. 

Meantime  pressure  was  being  brought  upon  the  Industrial 
Accident  Board  to  have  his  compensation  stopped,  as  the  medi- 
cal examination  by  the  company's  insurer  led  to  the  view  that 
there  was  no  reason  why  he  should  not  work.  It  appeared  to 
his  examiner  that  there  was,  or  might  be,  a  fixed  idea  of  in- 
ability to  work.  Accordingly  he  was  sent  to  the  Psychopathic 
Hospital.  There  it  was  found  that  he  showed  some  tubular 
vision,  or  so-called  limitation  of  visual  fields,  a  condition  which 
seemed  to  us  to  indicate  that  he  was  either  hysterical  or  inclined 
to  hysteria. 

The  idea  that  he  was  suffering  from  a  traumatic  hysteria, 
that  is,  a  traumatic  neurosis  of  a  rather  particular  nature,  was 
also  supported  by  finding  evidence  in  him  of  sudden  spells  of 
sweating,  sometimes  confined  sharply  to  one  side  of  the  body. 
This  so-called  "vasomotor  neurosis"  was  another  point  looking 
in  the  direction  of  traumatic  hysteria.  There  was  also  some 
evidence  of  diminution  of  sensory  power,  although  no  definite 
anesthesia.  On  the  more  psychic  side  of  the  man,  his  irritabil- 
ity, his  fear  of  falling,  and  a  newly  acquired  fear  of  walking 
in  the  open,  to  say  nothing  of  a  reluctance  to  working  further 
with  machinery,  were  other  points  fairly  consistent  with  the 
idea  of  a  traumatic  neurosis.  In  short,  John  Flynn  showed  sun- 
dry features  with  which  we  have  become  so  familiar  in  the  so- 
called  shell-shock  group  of  war  cases,  cases  in  which,  either 
with  or  without  actual  direct  violence  to  a  part  of  the  body, 
symptoms  of  a  general  or  special  nature  occur  (the  war  neu- 
roses, war  hysteria,  war-shock,  shell-shock)  and  as  in  many 
of  the  war  cases,  the  symptoms  were  somehow  determined  to 
a  side  of  the  body  on  which  or  near  which  the  blow  (windage) 
or  sound  occurred. 

The  medical  diagnostician's  impression  of  a  case  as  psycho- 
genic is,  of  course,  tremendously  heightened  by  the  determina- 


Il8  THE    KINGDOM    OF    EVILS 

tion  of  symptoms  to  the  side  on  or  near  which  the  exciting 
cause  was  delivered,  since,  by  and  large,  a  blow  on  one  side 
(say  the  left)  of  the  head,  with  injury  to  underlying  tissues, 
should  ordinarily  lead  to  symptoms  on  the  other  side  (say  the 
right)  of  the  body.  This  is  not  the  place  in  which  to  go  into 
the  question  of  the  so-called  "mechanisms"  of  hysteria,  yet  it 
is  of  importance  for  the  psychiatric  social  worker  to  know  upon 
what  a  delicate  knife-blade  the  diagnostic  decision  now  and 
then  depends.  Another  obvious  point,  here  worth  mentioning, 
is  that  amongst  physicians  themselves  all  such  cases  as  John 
Flynn's  deserve  attention  by  special  physicians. 

As  in  all  Industrial  Accident  cases,  (particularly  in  view  of 
their  later  possible  improvement),  the  psychometric  level  was 
determined.  He  was  not  regarded  as  feeble-minded  or  as 
having  shown  intellectual  deterioration,  grading  at  11.3  by  the 
Binet  Scale  and  12.5  upon  the  Point  Scale.  (These  differences 
are  due  to  certain  differences  in  the  tests,  which  do  not  argue 
any  fundamental  divergence  of  opinion  as  to  psychometric 
rating,  but  simply  go  to  show  that  the  methods  of  determining 
psychic  levels  are  not  yet  absolutely  established.  The  results 
are  found  trustworthy  within  certainly  a  year  or  so  of  the 
figure  given.  It  is,  of  course,  worth  while  eternally  insisting 
that  the  determination  of  even  a  low  level  of  intellectual  capac- 
ity does  not  argue  that  the  status  is  original ;  that  is,  that  the 
patient  is  a  feeble-minded  person.  The  decision  whether  we 
are  dealing  with  inborn  lack  or  acquired  loss  of  mind  remains 
a  delicate  one,  based  upon  psychiatric  estimate  of  symptoms  that 
pull  down  the  patient's  memory  capacity  below  his  normal  level 
and  of  course  must  depend  upon  data  as  to  the  patient's  social 
status.  No  doubt  the  previous  record  of  John  Flynn's  life 
would  absolutely  prove  that  he  was  not  feeble-minded  in  any 
ordinary  sense  of  that  term,  in  fact  we  felt  that  it  was  a  cer- 
tain psychopathic  depression  that  pulled  Flynn  down  even  to 
the  12.5  level  at  the  time  he  was  examined.) 

The  prognosis  was  rendered  that  John  Flynn  would  spon- 
taneously clear  to  a  large  extent  "within  an  unknown  period," 
and  it  was  added  that  our  tests  indicate  that  his  feeling  of  in- 
adequacy was  rather  an  objective  one,  despite  the  fact  that  he 
had  subjectively  added  a  great  deal  of  what  the  old  books  used 
to  term  "hypochondria."  This  suggestion  of  an  actual  objec- 
tive feeling  of  inadequacy  meant  to  show  that  the  insurer's 


THE    KINGDOM    OF    EVILS  II9 

physician  was,  perhaps,  not  right  in  thinking  that  the  patient 
was  objectively  able  to  work  to  full  capacity.  A  diagnosis  of 
plain  traumatic  neurosis  would,  on  the  contrary,  have  meant 
that  Flynn  would  have  been  set  down  as  a  man  objectively  able 
to  work  though  subjectively  unable.  There  was,  consequently, 
between  the  physicians,  no  issue  as  to  adequacy  for  work  at 
the  moment  subjectively. 

The  insurer  would  appropriately  take  the  attitude  that  a  man 
objectively  able  to  work  might  soon  become  subjectively  able 
(that  is  with  the  proper  social  or  medical  technique)  and  thus 
relieve  the  insurance  company  from  its  burden.  There  was, 
of  course,  no  question  throughout  of  simulation  or  a  conscious 
"faking,"  as  the  man  in  the  street  has  it.  We  are  therefore 
dealing  with  a  most  delicate  question  of  diagnosis,  wherein 
the  personal  equation  and  acquired  professional  slant  of  the 
diagnostician  must  inevitably  operate.  But  whether  the  pa- 
tient is  objectively  unable  to  work,  subjectively  unable  to  work, 
or  even  (as  in  not  a  few  Industrial  Accident  Board  cases)  ac- 
tually simulating,  at  all  events,  the  man  is  not  at  work.  The 
Industrial  Accident  Board  itself,  having  semi-judicial  powers 
and  impartiality  of  view  (all  sides  of  the  compensation  ques- 
tion being  represented  as  a  rule  in  its  make-up)  of  course  acts 
as  a  stabilized  social  service  mechanism ;  that  is,  as  a  bit  of  pub- 
lic machinery  that  has  rather  recently  grown  out  of  the  de- 
mands of  modern  social  service.  As  is  now  familiarty  known. 
the  Industrial  Accident  Board  representatives  can  be  of  direct 
community  help  and  individual  help  in  the  advice  they  offer 
to  the  victim  of  injury  as  to  whether  he  should  or  should  not 
take  a  "lump  sum"  settlement  or  continued  compensation. 
Which  of  these  lines  is  technically  better  depends  upon  the  case, 
and  "dependence  upon  the  case"  means  that  adequate  modern 
social  investigation  has  to  be  before  long  undertaken. 

A  decision  was  made  in  John  Flynn's  case,  whether  for  bet- 
ter or  for  worse,  (and  whether  permanently  for  better  or  worse 
remains  still  in  question),  to  grant  continuing  compensation 
decreasing  with  his  wages.  So  judicial  and  authoritative  is  the 
Industrial  Accident  Board  that  an  admixture  of  social  work 
not  of  quite  such  public  nature  is  often  advisable  in  cases  like 
John  Flynn's.  We  at  first  sent  him,  whilst  still  in  a  state  of 
almost  complete  inability  to  work,  to  a  cement  shop  conducted 
on  principles  of  occupational  therapy  at  a  near-by  hospital. 


I20  THE    KINGDOM    OF    EVILS 

Here  he  was  able  to  work  for  only  a  quarter  of  an  hour  at  a 
time.  He  was  rather  irritable  when  others  were  about  and 
had  to  be  given  work  by  himself.  The  occupational  therapy 
was  so  far  successful  that  at  the  end  of  three  months  he  had 
become  ready  for  light  employment.  He  became  an  elevator 
man  in  a  college  dormitory.  He  told  his  employer  about  his 
dizzy  spells  and  gave  the  impression  that  he  was  likely  to  faint 
rather  often.  At  first  the  prospective  employer  was  fearful. 
The  social  workers  explained  the  man's  exaggeration  of  his 
own  trend,  and  he  got  the  job.  With  the  help  of  one  of  the 
college  boys  he  was  kept  under  constant  supervision,  for  he 
needed  daily  encouragement.  The  work  was  light  and  the  boss 
favored  him  as  much  as  possible.  Days  when  he  felt  he  could 
not  go  to  work  alternated  with  more  hopeful  days.  He  suffered 
from  nausea,  weakness  of  legs,  dimness  of  vision.  By  almost 
imperceptible  degrees  he  has  improved,  until  now  a  year  and 
seven  months  since  he  came  under  treatment,  he  is  almost 
restored  to  a  firm  industrial  footing. 

He  did  not  lose  confidence  when  the  college  dormitory  closed 
for  the  summer,  but  with  guidance  found  another  suitable  job 
running  an  elevator  in  an  apartment  house.  Recently  his  tene- 
ment was  burned,  and  he  lost  many  of  his  household  goods;  but 
he  met  the  situation  competently  and  with  the  help  of  relatives 
has  gotten  together  another  home.  For  over  a  year  he  has 
been  in  great  anxiety  about  his  baby,  who  is  threatened  with  a 
serious  illness.  He  still  has  spells  of  stomach  trouble,  which 
has  improved  under  treatment. 

In  spite  of  all  these  difficulties  he  is  practically  well,  except 
for  minor  pains  and  feelings  of  discomfort,  and  slight  spells 
of  irritability,  symptoms  which  he  has  learned  how  to  control. 

That  this  case  is  a  psychiatric  one  in  the  sense  of  a  psycho- 
neurosis  there  can  be  no  doubt.  It  is  worth  the  social  worker's 
while  to  remember  that  all  depends  upon  the  point  of  view  of 
the  physician  whether  certain  psychiatric  cases  are  regarded 
as  psychiatric.  For  instance,  the  nausea  and  indigestion  of 
John  Flynn  secure  treatment  for  him  at  a  high-grade  general 
hospital  under  the  diagnostic  terms  "hyperacidity  and  gastropto- 
sis."  No  doubt,  good  clinical  proof  was  available  for  said  hy- 
peracidity and  gastroptosis,  but  no  doubt  also,  the  bull's-eye 
was  hardly  punctured  by  the  treatment. 

The  general  lines  of  treatment  in  John  Flynn's  case  may  be 


THE    KINGDOM    OF   EVILS  121 

summed  up  as  follows : — First  in  line  comes  encouragement. 
Work  of  graded  difficulty  to  comport  with  the  terraces  in  his 
improvement  was  indispensable ;  correlative  arrangements  with 
the  Industrial  Accident  Board  had  always  to  be  examined; 
Flynn's  eyes  had  to  be  examined  and  payment  arranged  for  by 
the  Industrial  Accident  Board,  to  say  nothing  of  the  treatment 
just  mentioned  and  payment  therefor  at  reduced  rates.  No 
less  than  sixteen  visits  to  the  wife  in  her  household  were  made 
in  the  period  of  thirty-two  months.  The  wife  we  found  to  be  a 
woman  of  even,  pleasant  disposition,  well-meaning,  but  rather 
ignorant  (her  mental  level  stood,  on  examination,  at  about 
1 1.6),  a  good  and  thrifty  housekeeper.  There  were  two  chil- 
dren. A  third  came  for  whom  some  arrangements  had  to  be 
made  with  the  Milk  and  Baby  Hygiene  Association.  Advice 
had  to  be  given  about  the  confinement,  and  a  visiting  house- 
keeper was  called  in. 

It  is  unnecessary  to  rehearse  the  evidence  for  placing  this 
case  amongst  cases  of  medical,  legal,  and  economic  difficulty. 
It  might  be  questioned  whether  Flynn  should  not  also  be  re- 
garded as  belonging  in  the  group  of  educational  difficulties. 
Certainly  more  or  less  advice  had  to  be  given  to  him  and  his 
family  along  lines  of  everyday  information.  Nevertheless,  the 
educational  defect  in  Flynn  himself  was  no  doubt  directly 
medical ;  that  is  to  say,  traumatic  in  origin.  Morally  speaking, 
Flynn  was  throughout  a  good  risk.  Our  latest  advices  about 
him  are  that  he  has  now  undertaken  a  more  complex  and  diffi- 
cult job,  which  he  performs  successfully. 

Hours  spent  by  Medical  record,  z^4  pages 

Social  record,  63  pages 
Physician,   14  Social  work : 

Visits,  32 
Psychologist,  i  Interviews  at  hospital,  34 

Telephone  calls,  137 
Social  worker,  89  Letters,  15 


Intelligent  sex  delinquent.  High  empathic  index.  Six  months 
in  a  state  hospital.     Voluntary  institution  care. 

Case  20.  Dora  Hadley,  like  Rose  Talbot  (case  8),  be- 
longs to  that  relatively  small  group  of  persons,  the  intelligent 
sex  delinquents, — at  least  we  may  speak  of  them  as  relatively 
rare  from  their  toll  in  clinic  records. 


122  THE    KINGDOM    OF   EVILS 

We  classified  Rose  Talbot  as  a  psychopath.  Presumably  she 
would  fit  in  the  heterogeneous  group  known  as  psychopathic 
personalities.  Perhaps  we  should  classify  Dora  Hadley  also 
here.  It  is  clear  that  the  term  sex  delinquent,  like  the  term 
delinquent  in  general,  makes  no  kind  of  psychiatric  diagnosis. 
There  are  delinquents  and  delinquents,  and  it  helps  to  solve  no 
problem  to  call  all  delinquents  a  priori  psychopathic.  The  plane 
which  separates  cases  like  Talbot  from  cases  like  Hadley  is 
perhaps  imaginary.  Nevertheless  around  the  circle  of  obvious 
psychopaths  is  another  circle  (or  is  it  a  matter  of  wider  and 
wider  circles?)  containing  persons  who  are  merely  in  some 
sense  eccentric  and  to  a  lesser  degree  off-center  than  the 
acknowledged  psychopaths. 

We  are  endeavoring  in  this  section  of  cases  to  report  all 
tertiary  combinations  of  social  symptoms.  If  we  stretch  a 
point  in  regarding  Dora  as  unmedical,  we  shall  not  damage  the 
main  contention,  which  is  that  Dora  Hadley  presents  no  par- 
ticular economic  problem  but  is  predominantly  a  moral  problem 
with  a  train  of  legal  entanglements  (eventually  leading  to  state 
hospital  care  for  six  months)  and  with  the  problem  of  moral 
and,  perhaps  more  important  still,  intellectual  instruction  in 
the  mid-center  of  the  picture. 

We  shall  give  below  the  rather  long  summary  of  Dora's  case 
as  a  sample  of  actual  case  records  which  the  student  may  use 
for  analytic  purposes  in  preparation  for  the  still  more  difficult 
analyses  of  original  records  on  which  such  summaries  are  based 
(at  the  end  of  this  book  are  examples  of  such  complete  records 
for  analytical  purposes),  l)ut  before  presenting  the  summaries 
we  may  give  a  still  briefer  resume  of  Dora  Hadley's  case  as 
follows : — 

Dora  Hadley  was  a  girl  of  respectable  family  of  fairly  good 
New  England  stock.  Dora's  mother  died  in  childbirth.  Al- 
though very  intelligent  (her  own  psychometric  tests  gave  her 
an  adult  age  level)  she  got  expelled  from  school  for  insubordi- 
nation. She  was  an  inmate  of  many  homes  which  were  scarcely 
"homes"  to  her.  She  lost  jobs,  ran  bills,  and  resorted  to  prosti- 
tution. Under  psychiatric  social  treatment  there  was  at  first 
little  progress.  She  remained  a  slack  worker  and  mischief- 
maker.  She  still  lost  jobs  which  were  got  for  her.  She  re- 
mained promiscuous  in  sex  relations.  She  even  took  to  drink- 
ing.    She  rather  naturally  got  blue  at  times  over  her  plight. 


THE    KINGDOM    OF   EVILS  12^ 

The  Story  would  not  be  properly  told  if  Dora's  beauty  of 
physique  and  vivacity  of  behavior  should  not  figure  therein. 
Everybody's  empathic  index  (as  someone  has  called  it)  for 
Dora  was  high — one  somehow  liked  to  see  oneself  in  such  a 
guise. 

Here  follows  the  summary  of  her  history  quoted  from  the 
social  record : — 

Social  History: 

Patient  is  a  girl  of  nineteen,  of  American  birth  and  parentage. 
Her  father  works  in  an  eyelet  factory.  Her  mother  died  when 
patient  was  one  week  old.  From  that  age  to  two  years,  she  was 
brought  up  by  paternal  grandmother,  where  she  remained  until 
fifteen.  There  were  two  half-sisters  only  a  little  younger  than 
herself.  From  the  age  of  fifteen  to  nineteen  patient  tried 
high  school,  but  flirted  with  boys,  whispered  and  did  not  do 
her  work,  so  that  she  was  asked  to  leave.  She  lived  with  sev- 
eral different  relatives,  and  two  families  in  which  she  worked. 
She  spent  six  months  at  the  Middlesex  State  Hospital.  She 
tried  factory  work  three  times  but  was  discharged  for  poor 
work  and  bad  conduct,  singing,  talking,  and  disturbing  others. 
In  the  spring  of  1914  she  became  acquainted  with  Elsie  Rich 
(also  a  patient  here)  of  the  State  Reform  School,  who  taught 
her  prostitution.  She  and  the  other  girl  met  men  in  a  ravine 
and  had  intercourse  for  money.  Went  to  hotels  in  Worcester 
for  dinners.  This  period  was  of  several  weeks  duration.  Dur- 
ing the  summer,  while  working  in  a  family  she  formed  an 
acquaintance  of  a  Harvard  student  of  good  reputation  which 
lasted  all  summer.  One  time  she  was  found  in  a  dark  hall 
dressed  in  a  kimono  sitting  in  his  lap.  In  January  she  was 
sent  to  Trinity  House  by  the  Children's  Society  who  had  been 
trying  to  help  patient's  family  to  care  for  her  in  the  past  two 
years. 

Physical  History: 

Patient  was  a  seven  months'  baby  but  developed  normally. 
She  was  six  months  in  care  of  Middlesex  State  Hospital  as  a 
voluntary  patient  in  1912.  Was  in  Psychopathic  Hospital 
January  27  to  February  15,  191 5. 

Her  mother  died  of  "peritonitis"  ten  days  after  her  birth. 
She  is  reported  to  have  had  "queer  spells"  every  few  weeks, 
when  she  did  not  lose  consciousness  but  was  unable  to  speak. 
The  attacks  were  preceded  by  a  vision  of  her  mother  or  hearing 
the  voice  of  her  mother.     An  aunt  on  the  maternal  side  was 


124  "rHE    KINGDOM    OF    EVILS 

demented  before  her  death  in  old  age.     The  paternal  grand- 
mother was  said  to  be  a  "gossip  and  trouble-maker." 

The  patient  is  lazy,  but  nervously  active.  She  is  strong  and 
in  good  health,  but  is  very  susceptible  to  pain. 

Mental  History: 

Patient  went  to  school  from  six  to  fifteen  years.  When  in 
the  ninth  grade  she  whispered  and  disturbed  other  students  so 
much  that  she  had  to  sit  in  the  sixth-grade  room  because  that 
teacher  was  better  able  to  control  her.  She  had  one  year  of 
piano  lessons.    Reads  some  good  classics. 

She  has  been  unsuccessful  at  work  because  she  cannot  apply 
herself  continuously  to  one  task.  In  housework  she  failed  be- 
cause she  was  unsystematic  and  careless.  She  bothers  others 
at  work  by  talking  or  singing  or  direct  conversation.  The 
patient  has  no  trade  but  wishes  to  be  a  nurse. 

She  takes  very  strong  likes  and  dislikes  but  is  fickle  and 
turns  against  a  person  as  soon  as  she  finds  he  is  no  longer 
useful  to  her  own  ends.  She  is  extremely  vindictive  and  spends 
a  great  deal  of  thought  on  how  she  can  "get  it  back"  at  anyone 
for  a  supposed  injury.     She  says  she  must  have  excitement. 

She  is  untidy  in  her  personal  appearance  and  takes  no  care 
of  her  clothes  or  room.  She  is  nervous  and  fidgety,  quick  to 
anger  and  very  fluent  in  expressing  her  anger.  She  is  com- 
pletely wrapped  up  in  herself  and  her  own  pleasures  and  ends, 
and  considers  no  one  else's  feelings.  The  patient  holds  lewd 
telephone  conversations  with  men.  picks  up  men,  deceives,  and 
lies.     She  runs  up  bills.     She  spends  her  earnings  on  clothes. 

From  infancy  she  has  had  crying  spells  and  when  younger 
would  hold  her  breath  until  she  was  blue  in  the  face.  She  has 
always  shown  a  brutal  strain  and  a  desire  to  torment  someone 
or  something — pinched  a  baby  she  cared  for  till  he  was  black 
and  blue.  In  the  same  way  she  makes  up  stories  to  injure 
people  she  knows.  Insinuated  to  a  woman  for  whom  she 
worked  that  her  husband  made  advances  to  her. 

Patient  thinks  she  has  been  ill  treated  and  that  her  half-sisters 
have  been  given  more  privileges  than  she.  Everyone  has 
knocked  her  about  she  thinks.  Has  no  fondness  for  parents, 
whom  she  considers  hypocrites. 

There  seemed  to  be  no  change  in  her  at  time  menses  began, 
but  a  gradual  development  of  this  character  from  early  child- 
hood. 

In  the  light  of  most  of  the  story  above  given  the  following 
letter,  restrained  and  stable  as  it  plainly  is,  is  a  bit  astounding, 


THE    KINGDOM    OF    EVILS  I25 

the  more  so  as  Dora  actually  did  make  good  her  promises 
therein. 

"My  Dear  Miss  Adams  : 

"I'm  very  sorry  I  went  away  from  you  as  I  did  Wednesday 
afternoon.  I  was  feeling  bad,  and  rather  cross  too,  because  of 
the  way  things  had  turned  out  in  the  last  week.  You'll  forgive 
me,  won't  you? 

"I  have  made  up  my  mind  at  last,  Miss  Adams.  I  am  tired 
of  leading  the  life  I  have  led  for  the  last  month.  Now  I  have 
given  up  my  freedom,  my  friends  (?)  and  am  going  to  put  in 
six  months  here  at  Trinity  House.  I  want  to  be  good.  I  simply 
cannot  trust  myself  as  much  as  I  hate  everything  immoral.  I'm 
not  immoral,  Miss  Adams, — I  hate  it.  I've  been  unmoral,  that's 
all.  You  understand  me,  don't  you?  And  I  think  you  believe 
in  me.  I  want  to  be  a  real,  true  woman.  I'm  going  to  be  one. 
I'm  going  to  try  so  hard  to  please  everyone.  Miss  Ellis  is 
beautiful  and  good.  I  love  her  and  Miss  Mansfield  and  I  want 
to  be  like  them,  just  the  kind  of  a  girl  they  want  me  to  be.  I 
can  do  it. 

"I  shall  miss  heaps  of  things.  I  want  to  see  someone  but  can- 
not. I  shall  be  lonesome  too — but  I'll  stick  it  out,  if  it  will  only 
help  me  to  be  what  I  want  to  be. 

"I  want  you  to  come  out  and  see  me,  and  surely  you  will 
write  to  me  ? 

"Sincerely, 
"Dora," 

She  not  only  at  our  suggestion  made  voluntary  resort  to  an 
institutional  home,  putting  herself  under  its  control  for  six 
months,  but  stayed  with  the  home  for  six  months  longer  than 
she  promised.  The  Psychopathic  Hospital  social  service  was 
then  emboldened  to  close  her  case.  She  is  now  doing  well  as 
a  nurse  in  training.  In  a  period  of  eighteen  months  or,  if  we 
count  the  state  hospital  term  as  sharing  in  her  progress,  two 
years,  Dora  climbed  a  considerable  terrace  educationally  and 
morally.  Lest  we  be  regarded  as  over-optimistic,  we  may 
remind  the  reader  that  the  White  Slave  Traffic  Investigation  in 
Massachusetts  some  years  since — an  investigation  headed  by 
Dr.  Walter  E.  Fernald — gavt  a  number  of  examples  of  prosti- 
tutes who  if  not  highly  intelligent  were  at  all  events  not  feeble- 
minded. In  fact  the  obviously  feeble-minded  among  the  pros- 
titutes of  that  investigation  were  but  slightly  over  fifty  per 
cent  of  those  examined  by  strict  mental  tests.    We  are  informed 


126  THE    KINGDOM    OF    EVILS 

by  Dr.  Fernald  that  the  woman  of  intelhgence  who  resorts  to 
prostitution  and  whose  case  is  not  otherwise  complex  is  very 
often  to  be  fomid  in  the  course  of  a  few  years  outside  the  tem- 
porary field.  Many  known  prostitutes  of  this  intelhgent  group 
have  settled  into  stable  married  lives. 

Hours  spent  by  IMedical  record,  39  pages 

Social  record,  31  pages 
Physician,   li  Social  work: 

Visits,  21 
Psychologist,  i  Interviews  at  hospital.  32 

Telephone  calls,  43 
Social  worker,  54  Letters,  13 


Unstable  Jewish  girl  with  obsessive  ambition  for  education. 

Case  21.  Bessie  Silverman,  a  nineteen-year-old  Russian 
Jewess,  came  to  the  out-patient  department  of  the  Psychopathic 
Hospital  of  her  own  volition.  She  came  by  herself  and  said 
that  she  wanted  to  find  out  her  mental  ability.  She  gave  her 
own  history.  Her  family  in  Russia  had  been  fairly  well-to-do, 
the  mother  was  dead,  and  her  father  had  married  again,  and 
emigrated  to  America  leaving  Bessie  in  Russia.  In  her  four- 
teenth year  Bessie  herself  came  over  and  interspersed  factory 
work,  which  she  shortly  undertook,  with  periods  of  schooling. 
The  dominant  issue  with  Bessie  was  to  get  an  education.  It 
was  rather  a  sharper  issue  with  Bessie  than  with  the  typical 
Russian  Jew  of  the  recent  American  scene.  Bessie  must  needs 
get  an  education  and  must  go  through  college,  and  the  issue  was 
still  sharper  when  her  ambitions  were  compared  with  those  of 
her  father  and  stepmother,  for  the  Silverman  family  had  in  a 
sense  come  down  in  the  world  since  their  immigration  to 
America.  Upon  examination  we  found  her  to  make  a  score 
of  17.5  years  with  87  points.  There  were  no  special  features 
in  the  examination  to  throw  clearer  light  upon  her  character. 
Her  afiswers  were  rather  slow  and  she  seemed  to  be  rather  less 
self-confident  than  most  persons  teking  these  tests.  Physically 
we  found  her  to  be  negative  except  for  a  spinal  curvature.  On 
the  whole  the  best  large  category  in  which  to  place  her  seemed 
to  be  that  of  the  psychoneuroses.  One  of  our  reports  speaks  of 
her  showing  a  kind  of  fundamental  disharmony  in  life,  a  dis- 


THE    KINGDOM    OF   EVILS  12^ 

harmony  based  on  the  incompatibiHty  of  her  ambitions  with 
her  immediate  opportunities  and  perhaps  with  her  own  mental 
capacity. 

The  principal  of  a  high  school  became  interested  in  her  upon 
our  proffering  him  the  case.  He  wrote  that  he  thought  he  had 
succeeded  in  arranging  a  reasonable  program  for  her  and  found 
her  in  a  good  frame  of  mind  for  work.  Carrying  this  school 
work  (in  which  she  really  needed  a  private  tutor  according 
to  the  school  view),  wearing  a  plaster  cast  for  her  lateral  curva- 
ture, and  earning  money  outside  formed  a  triple  weight  which 
she  was  hardly  able  to  carry.  All  the  while  she  seemed  to  re- 
sent the  social  crutch,  and  her  nervous  make-up  never  failed  to 
be  in  evidence. 

The  procedure  was  beset  with  difficulties.  The  central  idea, 
that  of  going  to  college,  we  eventually  decided  to  indulge.  She 
must  of  course  go  through  preparatory  school  first.  A  man 
of  means  who  had  taken  an  interest  in  the  Silverman  girl  (she 
was  rather  adept  at  making  friends)  undertook  to  finance  her 
going  to  a  suitable  and  expensive  preparatory  school.  This 
plan  must  needs  fail  on  account  of  Bessie's  determination  not 
to  accept  charity.  We  seem  to  have  reached  an  impasse.  She 
says  that  if  she  only  had  money  she  could  win  in  life,  but  as 
she  has  not  enough  money  and  will  not  take  it  she  therefore 
denounces  the  American  situation,  particularly  the  school  situa- 
tion. In  point  of  fact,  the  school  work  with  the  heavy  col- 
lateral burden  had  proved  too  much  for  her.  She  has  now 
reached  a  level  of  what  we  might  from  the  general  standpoint 
call  compensation.  She  is  doing  housework  for  weeks  or 
months  at  a  time  in  different  places. 

We  have  not  ticketed  Bessie  Silverman  as  distinctly  a  med- 
ical case,  finding  her  problem  to  be  one  of  moral  training  and 
of  economic  difficulty.  Yet  if  pushed  to  explain  her  case  we 
should  be  inclined  to  think  that  in  a  very  tenuous  way  there 
are  sundry  medical  difficulties  at  bottom.  At  all  events  there 
are  temperamental  faults  which  can  best  be  understood  by 
looking  in  the  psychiatric  direction.  The  social  service  and 
the  school  authorities,  to  say  nothing  of  her  general  American 
experience,  are  teaching  her,  if  not  her  level,  then  some  poten- 
tialities in  the  present  world.  It  might  be  easy  to  charge  up 
her  plight  to  something  racial  and  it  is  indeed  true  that  sundry 
Russian  Jews  do  appear  from  time  to  time  upon  the  social  scene 


128  THE    KINGDOM    OF    EVILS 

who  have  some  features  of  Bessie  Silverman.  We  are  inchned, 
however,  to  think  of  her  as  rather  specially  affected  by  a  psycho- 
neurotic trend.  Whether  her  general  disabling  through  incon- 
sistent ambition  is  so  much  an  educative  as  a  moral  affair  is 
also  doubtful.  The  economic  evidences  are  plain  enough,  but 
the  attitude  toward  them  which  Bessie  assumes  is  still  more 
troublesome.     It  is  easy  to  speculate  upon  the  outcome. 

Hours  spent  by  Medical  record,  12  pages 

Social  record,  ^-J  pages 
Physician,  4  Social  work  : 

Visits.  38 
Psychologist,  i  Interviews  at  hospital,  64 

Telephone  calls,  123 
Social  worker,  139  Letters,  40 


" Little  fiend ,"  a  neglected  child,  becomes  "the  pet"  of  a  foster 
household. 

Case  22.  Elliot  Calderwood  was  brought  to  us  as  a  "lit- 
tle fiend."  He  came  through  the  court.  His  aunt  had  found 
him  unmanageable  and  was  so  incensed  with  this  boy  of  eight 
years  that  she  refused  even  to  telephone  to  learn  our  findings 
and  refused  to  have  him  in  her  house  another  night.  His  aunt 
told  us  that  Elliot  was  wild  in  every  way,  could  not  eat  like  a 
decent  boy,  shuffled  his  feet,  ate  like  a  gourmand,  and  was  a 
frequent  and  sometimes  open  masturbator  who  had  attempted 
sex  relations  with  his  four-year-old  girl  cousin.  One  reason 
why  the  aunt  felt  so  desperately  concerning  her  nephew  was 
a  variety  of  facts  which  she  knew  concerning  his  father  and 
mother,  who  both  had  somewhat  checkered  sex  histories. 

The  small  boy,  observed  in  the  hospital,  was  found  to  be  a 
likable  afifectionate  small  boy,  who  admitted  much,  if  not  all 
that  his  aunt  maintained.  He  was.  however,  so  far  as  we  could 
make  out,  in  no  sense  a  medical  case.  He  measured  up  to  nor- 
mal psychologically.  He  had  learned  his  sex  practices  from 
various  adults  and  said  that  he  had  been  taught  also  by  them 
to  steal. 

The  need  of  a  careful  education  was  represented  to  a  chil- 
dren's agency  which  assumed  responsibility  for  the  boy's  sup- 
port and  thus  avoided  his  becoming  a  public  charge.     There 


THE    KINGDOM    OF    EVILS  129 

was  some  likelihood  that  the  father,  who  was  now  in  the  Cana- 
dian Army,  might  perhaps  be  reached  to  help  in  payments. 
(The  father  was  located  and  actually  did  make  an  allotment.) 
At  all  events,  the  children's  agency's  decision  was  greatly  justi- 
fied by  the  outcome  in  the  Calderwood  case.  The  boy  was 
circumcised  and  placed  in  a  country  town  with  a  kind  woman 
who  became  very  fond  of  him.  With  her  he  gave  no  trouble, 
ceased  masturbating  and  became  the  "pet"  of  the  household. 
We  present  this  case  as  one  of  threefold  disorder,  minus  the 
medical,  and  curiously  enough,  the  moral  complication.  We 
say  "curiously  enough"  because  a  case  brought  to  us  as  a  sort 
of  fiend  of  immorality  might,  perhaps,  be  regarded  as  one  of 
distinctly  moral  disorder.  To  be  sure,  the  moral  question  had, 
forthwith,  to  be  brought  up  for  discussion,  but  the  mental  tests 
and  the  general  hospital  observation,  to  say  nothing  of  his 
smooth  history  on  placing  out,  will  not  allow  his  being  classi- 
fied in  the  moral  group.  The  whole  situation  seemed  to  be  one 
rather  of  education,  and  upon  proper  intellectual  training,  the 
moral  pseudo-difficulty  disappeared.  We  place  him  in  the  legal 
group  because  he  came  to  the  hospital  through  the  court.  He 
was  a  neglected  child  and  an  economic  charge. 

Hours  spent  by  Medical  record,  12  pages 

Social  record,  3  pages 
Physician,  3  Social  work: 

Visits,  2 
Psychologist,  i  Interviews  at  hospital,  I 

Telephone  calls,  7 
Social  worker,  5  Letters,  2 


WOMAN.  43,  LR'IXG  AS  MAN 
12  YEARS 


IQI6 

.  1916-18 

Man's  Dress 

Woman's  Dress 

Inebriate 

Drinking  Spells 

Irregular  Work 

Steady  Job 

Bisexual  Delinq 

uency 

Books  and  a  Pipe 

Early  History: 

Married, 

Deserted 

Abandoned  Child 

Put  on 

Disguise 

Woman  who  lived  as  a  man.  Psychopathic  sexualis.  Alco- 
holism.    Became  a  steady  worker,  consoled  by  pipe  and  book. 

Case  23.  Julia  Brown  was  a  woman  who  lived  as  a  man. 
She  was  probably  in  the  late  thirties  when  she  first  came  to 
medical  attention.  Of  old  New  England  stock,  she  had  lived 
with  her  family,  father,  mother,  and  two  sisters  in  country 
towns  to  the  age  of  eleven,  whereupon  Julia's  mother  died  and 
her  father  married  again.  Julia  went  to  live  with  her  aunt. 
She  left  high  school  at  the  end  of  her  second  year  to  work  in  a 
mill.  After  a  year  in  the  mill  she  married  a  hard-drinking  man 
who  left  her  shortly  after  the  birth  of  a  baby  boy.  Putting 
the  baby  (whom  she  was  never  to  see  again)  in  her  aunt's  care, 
she  went  back  to  the  mill  and  worked  three  years.  In  the  late 
teens  or  early  twenties,  Julia  Brown  put  on  men's  clothes  and 
from  that  day  forward  never  wore  women's  clothes  again  until 
she  came  under  care.  According  to  her  story  she  was  con- 
stantly teased  for  looking  so  much  like  a  man.  She  thought 
she  could  get  work  more  easily  and  get  better  pay  as  a  man. 
Moreover  she  was  very  fond  of  girls.  After  donning  rnen's 
attire  she  assumed  the  name  of  Alfred  Mansfield.  She  began 
to  drink  and  to  smoke  a  pipe  incessantly.  She  lost  a  series  of 
jobs  on  account  of  her  drinking  habit.  There  were  no  other 
delinquencies  except  that  she  was  once  accused  of  stealing 
fifteen  dollars.  To  all  public  observation  she  was  well  behaved 
and  was  seldom  actually  seen  drunk.  In  general  she  led  a 
happy  life  according  to  her  own  conceptions,  and  was  accepted 
as  a  man,  fitted  into  the  social  life  on  the  chosen  level,  and  sang 
in  a  quartet  with  three  men,  etc.  For  a  year  she  kept  house 
with  a  girl  who  for  a  time  thought  that  Alfred  Mansfield  was 
a  man,  but  in  general,  according  to  her  story,  she  lived  alone. 

About  a  year  before  our  observation  she  came  to  Boston 
with  a  clairvoyant  for  whom  she  had  worked  in  another  city. 
She  helped  the  clairvoyant  for  some  weeks.  When  he  left  the 
city  she  got  work  as  painter  and  odd- job  man,  and  then  worked 
as  a  press-feeder. 

133 


134  'f'HE    KINGDOM    OF   EVILS 

Early  In  December,  191 5,  Alfred  Mansfield  was  overcome 
by  gas  and  next  day  found  herself  in  a  general  hospital.  She 
had  been  unconscious  in  the  interval.  She  denied  that  she 
had  turned  on  the  gas  with  suicidal  intent.  The  examination 
at  the  general  hospital  revealed  that  Alfred  Mansfield  was  really 
a  woman.  She  was  shortly  sent  to  the  Psychopathic  Hospital, 
no  doubt  in  part  because  of  the  history  of  concealment  of  sex, 
but  also  because  she  had  buzzings  in  the  ear  and  complained 
of  hearing  children's  voices.  There  was  never,  at  the  Psycho- 
pathic Hospital,  any  behavior  which  would  suggest  hallucina- 
tions and  no  further  complaint  of  voices. 

We  found  her  a  tallish,  well-developed,  and  rather  poorly 
nourished  woman  with  somewhat  heavy,  masculine  features, 
short  coarse  hair,  some  slight  evidence  of  beard,  and  a  low 
voice.  She  had  a  sizable  scar  on  the  left  jaw.  Her  teeth  were 
in  very  poor  condition.  She  suffered  from  flat  feet  but  other- 
wise showed  little  that  was  abnormal.  There  were  striae  of 
her  pregnancy.     Her  gait  was  masculine. 

The  gynecological  examination  proved  bacteriologically 
negative.  She  talked  readily  without  reticence  and  gave  a 
fairly  consistent  story  whose  dates  we  have  not  been  able  in 
all  details  to  verify,  but  there  was  clearly  no  general  tendency 
to  concealment  of  her  vital  record. 

Psychometrically  she  stood  by  the  point  scale  at  12.5  years 
and  by  the  Binet  Scale  at  a  slightly  lower  level;  namely,  11  3/5 
years.  After  the  details  of  these  tests,  it  seemed  that  her  free 
associations  were  retarded  and  her  interpretative  powers  (in 
the  tests  employed)  rather  poor.  On  the  other  hand,  her 
memory  span  was  fairly  wide  and  she  exhibited  a  fair  degree  of 
comprehension  and  powers  of  observation.  Her  learning  ability 
and  perception  of  form  proved  good  and  her  attention  fairly 
stable.  She  was  noted  as  oversuggestible.  The  psychologist 
concluded  from  the  psychological  standpoint  at  least  she  could 
not  be  regarded  as  feeble-minded. 

There  was  never  any  sign  of  a  definite  psychosis  or  of  any 
progressive  condition  suggesting  mental  disease.  It  was  clear 
that  she  belonged  amongst  the  psychopathias  or  psychopathic 
personalities,  or  possibly  she  could  be  put  in  a  group  of  eccen- 
tric persons  that  are  not  clearly  psychopathic ;  that  is  to  say, 
amongst  a  group  of  mild  psychic  anomalies.  From  her  own 
standpoint,  however,  her  life  was  fairly  self -consistent.     She 


THE    KINGDOM    OF    EVILS  135 

on  the  whole  felt  that  she  had  lived  a  happier  life  in  her  disguise 
and  had  more  money.  She  was  certain,  and  quite  tranquil  in 
her  assertion,  that  she  would  forthwith  go  back  to  her  life  as 
Alfred  Mansfield. 

Psychiatrically  we  found  her  without  active  symptoms  of 
any  sort.  She  remained  under  observation  at  the  Psychopathic 
Hospital  for  a  month.  She  then  had  to  be  transferred  to  a 
general  hospital  owing  to  a  throat  culture  positive  for  diph- 
theria. She  remained  technically  under  our  care  for  a  few 
more  days,  and  was  then  discharged  by  court  order  to  herself 
and  to  our  social  service.  We  determined  that  she  was  not 
insane  and  not  feeble-minded,  and  expressed  a  question  as  to 
her  being  a  victim  of  psychopathic  personality. 

The  situation  was  on  the  whole  rather  more  pathetic  than 
ludicrous.  The  net  result  of  the  social  work  in  her  case  is  that 
Alfred  Mansfield  has  gone  back  into  Julia  Brown  who  so  far 
as  we  know  (she  was  lost  to  notice  for  three  months  at  one 
time)  has  constantly  worked  and  has  betrayed  no  masculine 
tendencies,  unless  persistence  in  smoking  a  pipe  be  so  regarded. 
It  is  true  that  she  has  for  the  most  part  lived  in  somewhat 
questionable  lodgings  and  that  she  has  not  been  finically  neat 
in  her  life  there.  She  has  had  a  number  of  drinking  spells. 
One  night  she  came  home  drunk.  The  next  day  a  lodger  missed 
fifteen  dollars  and  charged  her  with  the  theft.  At  all  events, 
the  landlady  turned  her  out.  That  morning  she  staggered  away 
drunk  with  two  suitcases.  She  sat  down  upon  a  doorstep  to 
rest.  Someone  noted  a  pipe  sticking  out  of  her  pocket.  When 
the  police  arrived,  Julia  had  vanished,  leaving  the  suitcase 
wherein  the  police  found  men's  underwear  and  quantities  of 
strong  tobacco.  There  was  no  proof  of  the  alleged  theft,  the 
police  on  investigation  found  that  she  was  giving  satisfaction 
in  her  mill  work  (she  had  become  a  checker  of  stock  and  was 
well  liked,  even  having  been  made  secretary  of  an  employees' 
war  savings  stamp  club)  and  dropped  the  case. 

With  the  social  service,  Julia  Brown  has  been  on  the  whole 
rather  friendly  and  rather  passive  under  treatment.  When 
she  gets  into  a  fix  she  calls  upon  the  department  to  help  her. 
For  example,  her  drinking  at  one  time  badly  frightened  her  as 
to  its  possible  outcome  and  upon  her  desire  for  aid,  arrange- 
ments were  made  for  sending  her  to  a  state  hospital  as  an 
inebriate.     There    she    stayed    for    some    three    months    and 


136  THE    KINGDOM    OF    EVILS 

emerged  greatly  improved.  We  feel  that  she  has  been  restored 
to  that  level  of  normality,  or  subnormality,  which  could  in  all 
reasonableness  be  hoped  for. 

Apparently  during  her  life  as  Alfred  Mansfield  this  woman 
was  rather  sociable.  Now  she  is  a  good  deal  more  seclusiye. 
She  reads  classical  fiction,  smokes  strong  tobacco,  and  cannot 
be  broken  of  a  desire  for  spirits  which  she  drinks  at  home  alone 
We  have  closed  the  case  so  far  as  all  active  steps  are  concerned, 
but  naturally  expect  from  time  to  time  that  she  will  resort  to 
the  department  for  aid.  She  has  developed  an  ambition  for 
learning  some  technical  sort  of  work  which  can  be  performed 
at  home,  the  textile  products  of  which  could  be  sold  by  the 
piece.  The  point  seems  to  be  that  she  wants  to  make  a  home 
of  her  own. 

A  number  of  rather  human  questions  might  be  raised  by  this 
case.  On  the  whole  we  feel  that  the  present  approximation  of 
normality  is  a  good  deal  superior  to  the  previous  plight  despite 
the  seclusiveness  which  has  developed.  A  question  might  be 
raised  as  to  whether  she  should  be  put  in  contact  with  her  son, 
whom,  as  above  stated,  she  has  not  seen  since  he  was  a  few 
weeks  old.  For  the  sake  of  the  individual  happiness  of  her 
son,  it  has  been  for  better  or  worse  decided  that  no  special 
efforts  were  imperative  to  bring  mother  and  son  together.  In 
the  course  of  a  few  years  the  mother's  status  may  be  so  far 
improved  and  the  boy's  character  sufficiently  stabilized  to  war- 
rant a  set  attempt  at  reestablishing  relations.  The  woman  is 
herself  turning  her  thoughts  to  the  boy  and  the  family  relation. 
Recently  one  of  the  hospital  social  workers  met  Mrs.  Brown 
on  the  street.  She  seemed  pleased  by  the  encounter  and  stopped 
for  a  chat.  She  was  looking  well  in  a  new  spring  hat  and 
she  seemed  quite  satisfied  with  life.  One  of  her  favorite  ex- 
pressions is :  "Life  is  sweet  to  me." 

We  have  presented  the  case  as  one  of  non-medical  and  non- 
educational  nature,  although  it  would  be  easy  to  say  that  she 
is  so  far  a  victim  of  psychopathic  personality  that  medicine  has 
an  important  part  in  the  plot,  and  it  will  also  be  easy  to  show 
that  her  life  has  been  such  that  a  part  of  her  plight  was  due 
to  ignorance.  Nevertheless,  we  are  not  prepared  to  say  that 
she  is  definitely  a  psychopath  in  the  sense  of  sundry  cases  of 
overdeveloped  instincts  or  of  a  definite  psychopathia  sexualis. 
She  may  beloner  as  hinted  in  that  wide  and  vague  circle  of 


THE    KINGDOM    OF    EVILS  1 37 

eccentrics  and  cranks  that  lie  in  the  Umbo  outside  the  circle  of 
the  psychopathias.  Educationally,  the  woman  is  well  informed 
and  writes  a  good  letter ;  there  is  no  obvious  gap  in  education  to 
make  up.  On  the  other  hand  there  was,  of  course,  a  large 
moral  problem  and  the  question  of  readjustment  of  the  entire 
attitude  of  this  woman  to  her  life.  We  have  purposely  laid 
little  stress  upon  the  sex  delinquencies,  heterosexual  and  homo- 
sexual, which  are  suspected  or  implicit  in  some  parts  of  Julia 
Brown's  history.  With  a  case  of  congenital  psychopathia 
sexualis  we  question  whether  our  social  treatment  would  have 
been  so  relatively  successful  and  so  quickly  productive  of  re- 
sults as  the  above  account  indicates.  In  short,  the  readjust- 
ment problem  was  more  a  moral  than  a  psychiatric  one  despite 
the  fact  that  the  psychiatric  point  of  view  was  no  doubt  of  the 
utmost  service  in  picking  the  situation  to  pieces  and  parting 
out  the  moral  from  the  distinctly  psychopathic  elements  of 
Julia  Brown.  The  element  of  delinquency  needs  no  further 
analysis  than  what  the  history  reveals  and  the  economic  prob- 
lem, though  never  desperate,  required  a  good  deal  of  help  and 
indeed  from  time  to  time  actual  money  grants. 

Hours  spent  by  Medical  record,  27  pages 

Social  record,  48  pages 
Physician,  5  Social  work  : 

Visits,  49 
Psychologist,  I  Interviews  at  hospital,  14 

Telephone  calls,  53 
Social  worker,  gs^i  Letters,  21 


Depressed  cigar-maker;  could  not  work;  feared  open  spaces. 
Low  standard  of  living ;  family  problem. 

Case  24.  We  now  undertake  a  new  group,  the  binary 
combinations  of  social  trouble.  We  shall  find  ten  binary  com- 
binations, the  first  four  of  which  will  be  combinations  of  dis- 
ease with  some  other  form  of  social  trouble. 

David  Stone  was  a  Russian  Jewish  cigar-maker  who  came 
to  this  country  at  the  age  of  five.  We  medically  placed  him  in 
the  psychoneurotic  group. 

By  way  of  exemplifying  the  routine  summaries  of  social, 
physical,   and  mental   conditions   with   their   results,    we   here 


138  THE    KINGDOM    OF    EVILS 

insert  the  actual  text  (as  usual  with  the  names  and  certain  other 
features  changed)  from  the  social  record.  The  reader  should 
bear  in  mind  that  the  summary  is  of  the  social  records  and  not 
of  the  medical  records. 

RESULTS :  February  25-July  3,  1918 

Social: 

Work  was  found  for  patient  in  the  stock  room  of  a  wholesale 
cigar  plant  at  fifteen  dollars  a  week.  Patient  worked  there 
about  three  months  and  then  he  obtained  work  from  the  Stand- 
ard Life  Insurance  Company,  as  an  agent,  on  a  commission 
basis,  earning  about  twenty  dollars  a  week.  Patient's  wife  has 
not  been  working ;  two  hundred  and  twenty-five  dollars  security 
for  patient's  new  job  had  to  be  raised,  patient's  wife  getting 
this  through  the  Jewish  Free  Loan,  and  by  pawning  a  few  arti- 
cles as  well  as  by  borrowing  from  relatives.  Patient  is  paying 
back  at  the  rate  of  five  dollars  a  week  on  this. 

After  urging  by  social  service  family  moved  into  better 
quarters. 

Patient's  son  Arnold  was  ill  for  a  short  time  at  the  county 
hospital.  Made  a  good  recovery,  though  he  is  still  to  report  to 
the  out-patient  department  here. 

Patient's  wife  has  complained  of  a  uterine  disturbance  for 
which  a  private  physician  has  treated  her.  Social  service  re- 
ferred her  to  the  county  hospital  for  this. 

Physical: 

Nothing  of  note. 

Mental: 

Patient  likes  his  new  insurance  work.  Has  grown  less  and 
less  timid  about  going  about  alone,  declaring  himself  cured  the 
beginning  of  July,  1918,  Dr.  Myer  saying  he  need  not  report  to 
the  out-patient  department  unless  he  wanted  to.  He  took  this 
new  work  as  he  saw  in  it  more  chance  of  advancement.  Patient 
has  reported  to  the  out-patient  department  several  times. 

July  3-October  3,  1 91 8 
Social: 

Family  have  moved  to  47  Wall  Street,  Roxbury,  a  better 
section,  where  they  have  three  large  rooms ;  the  rent  being  nine 
dollars. 

Patient's  niece  is  wife  of  a  cosmetic  specialist  who  uses  the 


THE    KINGDOM    OF   EVILS  1,39 

fourth  room  in  front  of  the  tenement  as  a  store  for  his  wares, 
and  reduces  the  rent  to  nine  dollars  in  return  for  occasional 
services  of  patient's  wife  in  the  store.  Patient's  wife  is  not 
doing  any  other  work.  Social  service  arranged  for  her  and  the 
children  to  have  a  vacation  during  the  summer,  which  benefited 
them  considerably. 

Patient's  wife  puts  off  her  own  treatment  at  the  county  hos- 
pital or  by  her  physician.  She  has  not  taken  Arnold  to  the 
county  hospital  as  she  should. 

Patient  is  still  working  for  the  Standard  Insurance  Company, 
earning  twenty-one  dollars  a  week.  He  works  mornings,  rests 
in  the  afternoon,  and  finishes  work  in  the  evening.  Patient  is 
still  paying  back  at  the  rate  of  five  dollars  a  week  for  the 
amount  borrowed  for  security. 

Physical: 

Patient's  condition  is  about  the  same.  He  was  overcome  by 
the  heat  in  the  summer  but  is  able  to  do  his  work  now. 

Mental: 

Patient's  son  or  wife  frequently  accompanied  patient  at  his 
work,  the  heat  having  made  patient  afraid  to  go  out  alone  for 
fear  of  fainting.  He  has  reported  a  few  times  to  the  out-patient 
department.  His  work  is  still  that  of  agent  at  the  Standard  Life 
Insurance  Company,  which  he  enjoys  very  much. 

October  3,  1918-January  3,  1919 
Social: 

Patient  is  still  working  for  the  Standard  Life  Insurance 
Company  as  agent,  earning  twenty-three  dollars  for  the  past 
quarter,  which  is  almost  up.  He  is  still  paying  back  his  money 
borrowed  at  the  rate  of  five  dollars  a  week,  and  is  paying  one 
dollar  a  week  on  a  fifty-dollar  Liberty  Bond  recently  taken  out. 

The  family  are  still  living  at  47  Wall  Street,  Roxbury,  which 
is  proving  a  very  satisfactory  home  considering  the  cheapness  of 
the  rent.  They  were  very  appreciative  of  the  second-hand  bed 
and  mattress  provided  through  the  social  service. 

Patient's  wife  still  has  not  had  adequate  medical  attention  for 
herself.  She  refused  treatment  in  the  county  hospital  because 
she  does  not  approve  of  the  medical  students  being  present  in 
clinic,  and  defers  visiting  the  Norton  Hospital  on  one  ground  or 
another.  She  and  the  three  children  have  had  influenza  recently 
but  did  not  have  serious  attacks. 


140  THE    KINGDOM    OF   EVILS 

Physical: 

Patient  probably  had  influenza  in  October,  but  did  not  have  a 
serious  attack.  Since  then  he  has  been  feeling  stronger  than  he 
has  for  several  months. 

Mental: 

Patient  has  been  steadily  improving  in  his  ability  to  go  out 
alone,  his  wife  accompanying  him  less  and  less  frequently.  Now 
he  goes  to  work  alone  practically  all  the  time.  For  the  past  two 
months  he  has  worked  very  hard  to  make  up  for  the  time  he 
lost  in  the  heat  of  summer.  He  works  overtime  when  he  takes 
a  holiday,  such  as  Thanksgiving  and  Christmas.  He  is  very 
enthusiastic  about  his  work  and  pleased  with  his  increase  in 
salary.  Patient  has  been  in  out-patient  department  once.  Seen 
by  Dr.  Jones,  who  prescribed  medicine  as  a  nerve  tonic,  which 
Dr.  Jones  felt  sure  would  have  immediate  results. 

January  3-May  3,  1919 

Social: 

Patient  continues  to  work  for  the  Standard  Life  Insurance 
Company  from  twenty-five  dollars  to  forty  dollars  a  week.  His 
debts  are  almost  paid  ofif.  He  still  lives  at  the  same  address.  His 
wife  has  been  examined  In'  the  physician  who  attended  her  in 
the  first  confinement.  She  thought  she  could  afiford  this  luxury. 
The  doctor  told  her  that  she  was  in  good  condition,  the  only 
pathological  finding  being  a  nervous  stomach  which  she  could 
disregard.  She  is  anxious  to  arrange  a  good  vacation  for  the 
children  in  some  way  and  thinks  it  would  help  patient  if  they 
could  find  a  cheap  summer  home  from  which  he  could  commute. 

Physical: 

Conditions  are  negative. 

Mental: 

Patient  had  one  somewhat  depressed  spell  in  February,  Dr. 
Jones,  out-patient  department,  thinking  it  pointed  possibly  to 
manic  depressive  insanity  as  patient's  real  diagnosis.  Patient's 
wife  explained  it  as  his  usual  reaction  when  seasons  change,  and 
as  due  also  to  the  fact  that  his  salary  was  not  increased  as  much 
as  he  had  been  led  to  believe  by  a  mistake  on  his  employer's  part. 
This  did  not  keep  him  from  work,  however,  and  after  a  few 
days  he  was  as  well  as  ever.  He  says  his  own  mental  attitude 
has  been  his  salvation  since  he  came  to  the  hospital. 


THE    KINGDOM    OF    EVILS  I4I 

He  is  concerned  lest  he  be  unable  to  give  his  children  a  good 
education.  He  came  in  willingly  to  be  presented  at  a  clinic  for 
employment  managers  in  April,  and  impressed  the  group  as  a 
fully  recovered  man.  He  says  he  likes  to  do  anything  he  can  tor 
the  hospital  and  for  others  ill  as  he  has  been,  and  he  has  inquired 
with  interest  for  a  patient  to  whom  he  gave  vocational  advice 
here  six  months  ago. 

We  present  this  case  as  a  combination  of  medical  and  educa- 
tional difficulty.  There  is  obviously  very  little  actual  character 
disorder  save  that  which  is  involved  in  the  psychoneurosis  it- 
self :  On  this  account  we  do  not  classify  Stone  as  a  case  in 
which  moral  measures  need  systematically  to  be  explained.  Nor 
were  there  any  legal  complications  of  note.  The  observer  who 
found  them  living  in  their  four  dark  rooms  (five  sleeping  in 
one  room  whose  window  had  to  be  kept  closed  on  account  of 
an  odorous  alley)  might  at  first  sight  suspect  moral  difficulty. 
This,  however,  was  not  at  all  in  evidence  save  for  the  facts 
noted  above.  The  social  symptoms  summarized  were  as  fol- 
lows :  spouse  working,  housing  bad,  employment  irregular, 
failure  in  business,  debts,  and  selfishness.  If  it  be  objected  that 
"selfishness"  is  not  in  itself  a  social  symptom  in  the  strict  sense, 
nevertheless  selfishness  has  such  a  marked  social  effect  that  it 
may  well  stand  for  a  whole  sheaf  of  social  symptoms. 

David  Stone's  medical  deficiency  is  plain.  How  can  we 
define  the  deficiency  we  regard  as  educational  ?  Here  was  a  not 
infrequent  family  type,  strongly  anticapitalistic  and  socialis- 
tically  well-read,  yet  their  living  and  housing  conditions  were 
bad  (perhaps  one  ought  not  to  say  bad  deliberately  but  bad 
through  a  kind  of  lack  of  social  sense,  through  a  mind  of 
social  apathy  or  thoughtlessness).  Such  living  and  housing 
conditions  obviously  combined  with  David  Stone's  psycho- 
neurosis  to  form  in  some  sense  a  new  compound  sort  of  social 
defect.  Neither  psychotherapy  alone  however  skillfully  leveled 
at  the  psychoneurosis  nor  the  cleverest  neighborhood  work  di- 
rected at  the  cubical  contents  of  the  Stone  tenement  would,  by 
itself,  afTect  that  social  cure  of  the  family  plight.  It  is  the 
obvious  thing  to  say  that  David's  fear  of  open  spaces  and  the 
family  habit  of  living  in  a  sort  of  crevice  in  the  world  is  some- 
how racial  and  a  matter  of  the  ghetto.  How  ingrained  or  how 
superficial  the  alleged  ghetto  loves  of  this  race  really  are,  we 
are  not  competent  to  discuss.     Suffice  it  to  say  that  not  every- 


142  THE    KINGDOM    OF   EVILS 

body  in  the  ghetto  is  psychoneurotic  and  that  many  a  Russian 
Jewish  point  of  view  gets  in  a  rather  brief  time  complete  illumi- 
nation on  these  and  other  matters  in  our  American  scene.  Be 
all  this  as  it  may,  the  low  educational  level  of  a  family  like  the 
Stone  family  was  something  social  to  be  wrestled  with. 

Throughout  these  binary  combinations  of  social  trouble  we 
shall  find  ourselves  inquiring  whether  the  two  conditions  each 
time  in  evidence  are  intimately  or  loosely  combined.  We  shall 
ask  whether  they  are  combined  so  intimately  as  to  form,  as  it 
were,  a  new  compound  such  that  the  social  treatment  entailed 
is  not  merely  a  subtraction,  one  by  one,  of  the  two  problems 
from  the  patient's  life,  but  requires  a  novel  form  of  handling. 
It  is  clear  in  Stone's  case  that  a  strict  agoraphobia  or  fear  of 
open  spaces  was  primary  in  his  psychoneurosis,  was  in  some 
sense  identical  with  the  intentions  or  motives  underlying  a 
strictly  unnecessary  life  in  a  tenement.  We  are  tempted,  there- 
fore, to  say  that  the  Stone  compound  of  disease  and  ignorance 
was  a  rather  intimate  product  of  the  two  factors  working  upon 
each  other. 

The  Stone  problem  is  now  happily  almost  settled.  Curiously 
enough  the  main  problem  that  exercises  the  mind  of  the  now 
stabilized  paterfamilias  is  the  education  of  his  children. 

Hours  spent  by  Medical  record,  6  pages 

Social  record,  21  pages 
Physician,  14^  Social  work  : 

Visits,  19 
Psychologist^  o  Interviews  at  hospital,  10 

Telephone  calls,  46 
Social  worker,  37^/2  Letters,  13 


Steady  employee  of  good  character  who  pilfered.  Epileptic 
wife:  marital  discord.  Social  treatment  depends  upon  correct- 
ness of  medical  diagnosis. 

Case  25.  Alfred  Stevens  is,  no  doubt,  a  case  of  the  so- 
called  cyclothymia  group.  He  has  been  three  times  voluntarily 
a  patient  at  the  Psychopathic  Hospital  and  although  the  first 
time  there  was  a  question  between  manic-depressive  psychosis 
and  psychoneurosis  the  settled  diagnosis  was  manic-depressive 
psychosis.     We  are  not  in  this  book  discussing  the  medical 


THE    KINGDOM    OF   EVILS  1 43 

aspects  of  psychiatry,  yet  it  is  important  for  the  psychiatric 
social  worker  to  remember  that  the  cyclothymic  (manic-de- 
pressive) group  of  disorders  is  on  the  whole  theoretically  quite 
separate  from  the  group  of  psychoneuroses.  The  psycho- 
neuroses  (hysteria,  neurasthenia,  psychasthenia)  are  on  the 
whole  diseases  both  theoretically,  and  very  often  practically, 
influenceable  by  psychotherapeutic  methods.  It  would  be  al- 
most safe  to  generalize  that  the  psychoneurotic  group  is  the 
psychotherapeutic  group  par  excellence.  The  cyclothymic 
(manic-depressive)  group  of  disorders  is  theoretically  non- 
influencable  by  the  psychotherapeutic  technique,  although 
cycloth3^mics,  like  all  other  persons  normal  or  subnormal,  are 
to  some  degree  influenceable  in  subordinate  features.  On  the 
whole  the  attacks  of  emotional  disorder  that  characterize 
cyclothymia  and  are  expressed  in  its  Greek  designation  are  self- 
limited  in  their  course  and  not  controllable  in  the  degrees  of 
their  severity.  The  typical  cyclothymia  (manic-depressive 
psychosis)  will  show  attacks  of  emotional  disorder  sometimes 
depressive  and  sometimes  maniacal  (the  medical  denotation  of 
this  term  maniacal  covers  all  degrees  of  excitement  down  to 
mere  psychopathic  illusion  or  hypomania),  but  not  all  cyclo- 
thymics show  maniacal  attacks  and  some  of  them  never  show 
any  phenomena  that  are  not  clearly  depressive.  Alfred  Stevens 
was  in  point  of  fact  the  victim  of  a  sort  of  a  constitutional 
melancholia.  He  was  of  a  brooding  and  seclusive  tempera- 
ment without  outside  interests.  He  was,  however,  not  of  a 
complaining  sort  and  had  no  tendency  to  feel  persecuted. 

For  years  he  held  a  good  job  in  a  dry-goods  firm,  and,  as 
transpired  in  the  sequel,  he  was  given  to  continual  small  pil- 
ferings,  a  habit  of  over  ten  years'  duration.  A  moral  compli- 
cation of  the  Stevens  case  was  that  beyond  question  the  wife 
knew  of  these  pilferings  but  on  some  ground  condoned  them, 
A  trunkful  of  ribbons,  laces,  collars,  etc.,  was  found  in  the 
house.  The  firm  did  not  press  the  pilfering  issue  but  discharged 
Stevens  on  another  pretext.  He  was  not  without  some  sense  of 
the  real  reason  of  the  discharge. 

Can  we  connect  the  pilfering  with  the  man's  cyclothymic 
temperament?  Pilfering  might  on  an  oversimple  schematic 
basis  be  regarded  as  a  sort  of  overdevelopment  of  the  acquisi- 
tive instinct.  The  acquisitive  instinct  might  stand  out  in  relief 
on  the  general  background.    This  at  least  is  the  hypothesis  for 


144  THE    KINGDOM    OF    EVILS 

sundry  of  the  special  forms  of  psychopathia  (kleptomania, 
wanderlust,  etc.)  with  which  we  are  familiar.  In  this  instance, 
however,  we  are  not  so  much  inclined  to  attribute  the  pilfering 
to  any  trend  toward  kleptomania  as  to  the  effects  of  a  certain 
weak-zvilledness  or  hypohiilia  more  closely  related  with  the 
man's  general  make-up. 

He  was  a  rather  effeminate  and  timid  man.  Without  sug- 
gestion of  homosexuality,  he  has  always  been  "a  regular  sissy," 
had  been  unduly  finical  about  his  clothing,  had  not  smoked  or 
drunk,  had  no  sense  of  humor,  had  no  interest  in  religion,  had 
always  preferred  to  be  alone,  made  little  sexual  demands  (sex 
interest  absent  for  ten  years),  and  did  not  want  guests  about 
the  house.  However,  he  did  want  to  please  his  wife,  and  doted 
on  his  little  girl.  The  wife  was  frankly  an  epileptic  and  had 
sundry  seizures  upon  the  street  and  elsewhere.  Despite  his 
kindliness  with  his  wife,  there  was  a  good  deal  of  irritability 
in  the  home,  no  doubt  largely  due  to  the  wife's  temperament. 
Indeed  this  epileptic  wife  has  twice  left  Stevens  and  had  in  fact 
shortly  before  Stevens'  appearance  at  the  hospital  definitely  de- 
cided to  leave  him  for  good. 

Psychometrically  Stevens  stood  at  11.3,  making  a  general 
intelligence  score  of  68  upon  the  Yerkes  scale.  At  the  time  of 
examination  his  chronological  age  was  forty-six,  the  irregular- 
ity in  the  tests  stood  at  nineteen  points,  and  the  irregularities 
stood  out  especially  upon  the  supplementary  tests.  He  made  at 
the  time  a  very  poor  score  on  tests  of  immediate  memory  and 
upon  the  construction  puzzles,  despite  the  fact  that  his  coopera- 
tion, interest,  and  attention  were  very  good.  The  irregularity 
of  his  examination  was  interpreted  as  suggesting  psychosis 
rather  than  inborn  feeble-mindedness. 

Manic-depressive  psychoses  and  the  cyclothymias  in  general 
are  rather  characteristically  hereditary  in  the  sense  that  there 
are  frequently  two  or  more  relatives  of  a  cyclothymic  patient 
that  also  show  psychopathy;  often  indeed  the  psychopathy  of 
the  relative  is  also  cyclothymic.  In  point  of  fact,  Stevens' 
father  had  died  in  an  English  hospital  for  the  insane,  and  a 
sister's  child  has  been  fifteen  or  more  years  insane  in  an  Eng- 
lish hospital.  However,  two  brothers  are  in  the  English  Army 
and  so  far  as  known  normal,  and  there  is  a  second  sister  who 
is  apparently  without  taint.  The  mother's  cancer  is,  so  far 
as  we  know,  without  significance  for  heredity. 


THE    KINGDOM    OF    EVILS  I45 

With  respect  to  social  treatment,  it  will  be  remembered  that 
the  medical  diagnosis  upon  his  first  appearance  upon  the  hos- 
pital scene  lay  in  doubt  between  cyclothymia  and  psycho- 
neurosis.  Indeed  the  man's  general  appearance  was  rather 
suggestive  of  psychoneurosis,  and  the  constitutional  melan- 
cholia shown  in  his  history  got  rather  easily  an  interpretation 
as  psychoneurosis.  Stevens'  finicalness  bore  some  resemblance 
to  the  psychasthenic  obsessions  of  that  form  of  psychoneurosis 
known  as  psychasthenia.  He  would  sit  in  the  out-patient  de- 
partment weeping,  and  strike  the  observer  as  greatly  in  need 
of  comfort  and  counsel  along  lines  that  might  be  called  psycho- 
therapeutic or  common-sense  lines,  according  to  the  termi- 
nology preferred.  Comfort  and  counsel  would  indeed  cause 
him  somewhat  to  brace  up,  though  the  underlying  tempera- 
ment obviously  persisted. 

The  first  idea  of  the  social  work  was  to  rationalize  the  atti- 
tude of  this  supposed  psychoneurotic  pilferer  to  his  stealing. 
Some  progress  was  made  in  this  rationalization  process.  De- 
spite minor  successes  of  our  counsel,  on  the  whole  no  progress 
was  made  in  altering  the  man's  entire  attitude  to  his  life,  espe- 
cially as  to  steadiness  in  employment  and  attitude  to  wife  and 
child.  Before  he  came  to  the  hospital  he  had  had  no  less  than 
twelve  jobs  in  eight  months. 

As  soon  as  the  medical  diagnosis  clearly  pointed  to  cyclo- 
thymia instead  of  psychoneurosis,  hospital  care  could  rationally 
be  advocated  rather  than  out-patient  counsel.  He  was  sent,  or 
rather  voluntarily  went,  to  a  state  hospital  and  the  situation  in 
the  course  of  a  few  weeks  "was  so  altered  that  although  he  left 
against  advice  he  had  gotten  upon  another  temperamental  level 
and  was  prepared  for  steady  work.  In  fact,  he  found  such 
steady  work  for  himself.  Since  this  time  no  further  special 
steps  in  social  treatment  have  been  necessary,  his  wife  has  come 
back,  and  a  new  home  has  been  started.  As  to  the  pilfering 
history,  Stevens'  conscience  does  not  now  trouble  him.  He 
has  rationalized  the  pilfering  as  due  to  his  mental  disease. 
Whether  this  is  profoundly  true  or  not,  a  solid  readjustment 
toward  his  past  has  accrued. 

It  is  plain  that  the  treatment  is  not  in  any  sense  an  "elabo- 
ration of  the  obvious."  The  differential  medical  diagnosis 
betwixt  cyclothymia  and  psychoneurosis  proved  a  most 
important  one  for  Stevens'  quick  restoration  to  self-sup- 


1^6  THE    KINGDOM    OF   EVILS 

port.  Medical  practitioners  as  a  group  are  not  too  well-in- 
formed with  what  they  are  rather  apt  to  think  a  superfine  dis- 
tinction between  mild  degrees  of  mental  disease.  Many  a 
case  of  mild  cyclothymia  (manic  depressive)  and  even  of 
mild  schizophrenia  (dementia  praecox)  has  been  diagnos- 
ticated psychoneurosis  over  periods  of  months  and  years. 
Close  observation,  psychological  examination,  and  social  his- 
tory (including  points  got  from  the  non-effect  of  some  of  the 
early  steps  in  social  treatment)  here  combined  in  a  compara- 
tively brief  period  to  assure  the  correct  diagnosis,  and  the  cor- 
rectness of  this  diagnosis  meant  shifting  the  whole  front  of 
treatment. 

In  summing  up  the  analysis  of  Alfred  Stevens,  we  need  dwell 
no  further  upon  the  importance  of  the  medical  side.  There 
was  no  important  gap  of  ignorance  to  fill.  Luckily  the  pilfer- 
ing never  reached  a  legal  phase,  the  economic  difficulties  were 
implaced  in  the  medical  situation,  and  on  the  whole  rather 
easily  met.  Whether  Stevens  is,  narrowly  speaking,  an  ethical 
case  might  stand  in  question;  yet  we  do  not  regard  his  pilfer- 
ing as  either  implaced  in  the  manic-depressive  psychosis  or  in 
any  plain  psychopathic  trend.  There  was  distinctively  a  moral 
attitude  assumed  by  him  and  by  his  wife  toward  pilfering 
habits  of  ten  years'  duration.  A  new  moral  attitude  toward 
stealing  had  to  be  instilled. 

Hours  spent  by  Medical  record,  53  pages 

Social  record,  36  pages 
Physician,   10  Social  work: 

Visits,  21 
Psychologist,  2  Interviews  at  hospital,  23 

Telephone  calls,  28 
Social  worker,  52  Letters,  9 


Arrested  under  "work  or  fight"  law;  a  case  of  mental  disease. 
Commitment.     Provision  for  the  family. 

Case  26.  Kevork  Ardinian  was  suddenly  arrested  under 
the  "work  or  fight"  law,  but  was  shortly  thereafter  sent  to 
the  Psychopathic  Hospital,  being  committed  from  the  court 
for  observation.  The  situation  was  somewhat  strange. 
Ardinian  was  an  open-faced,  smiling  young  Armenian  who 


THE    KINGDOM    OF    EVILS  147 

had,  until  very  recently,  been  a  hospital  porter.  He  worked 
alongside  his  wife  in  a  general  hospital  and  he  had  saved  a 
little  money  so  that  they  could  be  classed  as  "independent" 
rather  than  marginal  in  our  economic  classification.  Ardinian's 
wife  was  already  advanced  in  pregnancy  when  he  was  dis- 
charged for  refusing  to  do  part  of  his  assigned  work.  He 
said  that  he  had  headaches,  and  stood  about  complaining  on 
the  streets  in  an  Armenian  neighborhood.  He  occasionally 
smiled  to  himself.  (This  causeless,  silly  smiling  is  a  char- 
acteristic symptom  of  the  disease  schizophrenia-dementia  prae- 
cox — from  which  Ardinian  was  later  thought  to  be  suffering, 
but  it  does  not  do  to  draw  definite  conclusions  from  any  single 
symptom  in  mental  disease.)  As  for  any  adequate  reason 
for  his  suddenly  ceasing  to  work,  Ardinian  could  give  none, 
but  simply  replied  gently  that  he  did  not  need  to  work  as  he 
had  enough  money  in  the  bank  for  a  time.  He  said  that  more 
money  would  come  to  him,  possibly  from  the  government.  In 
line  with  his  silly  smiling,  he  was  observed  to  be  rather  de- 
tached in  manner  and  a  bit  playful,  although  not  saucy,  with 
women.  He  had  a  somewhat  oversweet  manner  with  them. 
He  fell  into  silence  when  reproved,  kept  to  himself,  and  was 
inclined  to  tease  his  neighbors,  for  example,  leaving  laundry 
baskets  in  the  aisle  for  the  fun  of  making  the  people  walk 
around  them. 

That  a  man  could  be  both  smiling  and  stubborn,  as  was 
Ardinian,  seemed  to  argue  an  abnormal  mixture  or  compound 
of  emotions.  Such  queerly  mixed  emotions  (sometimes  termed 
by  the  psychiatrists  "parathymia"  or  even  "schizothymia"  hav- 
ing reference  to  the  dissociation  or  split  in  emotions  found  in 
schizophrenia)  would  rarely  appear  in  any  other  disease  group 
than  the  schizophrenia  group. 

Psychologically  they  found  Ardinian  to  rate  at  13.3.  The 
non-English  norms  were  used,  and  an  interpreter  was  present. 
The  psychologist  reported  that  Ardinian  would  perhaps  have 
done  better  if  he  had  not  refused  altogether  to  do  the  form 
association  test  and  the  three-words-in-a-sentence  test.  His  co- 
operation was  rather  poor.  When  non-English  norms  are  used 
in  determining  the  psychological  level,  the  practice,  of  course, 
is  to  allow  sundry  points  for  the  supposed  inability  to  do  some 
of  the  tests  that  require  certain  educational  capacities.  Ac- 
cordingly it  is  always  possible  to  allow  too  much  or  too  little 


148  THE    KINGDOM    OF    EVILS 

to  patients  who  are  tested  by  the  non-EngHsh  norms.  There 
was  no  question,  in  any  case,  of  moronity  or  feeble-mindedness, 
which  would  argue  a  mental  age  from  nine  to  eleven  inclusive. 
Here  was  a  man  with  some  deficiency  on  test.  We  are  prob- 
ably able  to  argue  from  his  social  history  that  he  was  not,  at 
the  outset,  feeble-minded  even  in  the  slight  degree  that  lies 
above  moronity  and  below  normality. 

We  are  not,  in  this  book,  discussing  psychological  levels  or 
their  determination,  but  it  is  clear  that  the  social  worker,  like 
the  psychiatrist,  must  never  view  the  psychological  level  as 
determined  completely  out  of  its  social-psychiatric  setting. 
Viewed  in  the  social  and  psychiatric  setting,  these  psychological 
level  determinations  are  amongst  the  most  powerful  agents  we 
possess  in  diagnosis. 

Physically  we  found  no  special  signs  of  disease  or  abnor- 
mality. It  would  not  do  to  regard  overactive  knee  jerks  and 
irregular  pupillary  margins  as  of  great  importance.  There 
was,  however,  a  slight  protusion  of  the  eyeballs  that  his  friends 
had  latterly  noted  as  unusual.  Whether  this  slight  exophthal- 
mos could  be  regarded  as  pointing  to  some  slight  degree  of 
Graves'  disease  is  doubtful.  The  thyroid  was  not  palpable, 
and  the  pulse  was  not  increased.  There  were,  however,  some 
tremors  of  hands  and  tongue. 

Psychiatrically  he  proved,  for  the  most  part,  normal.  There 
were  of  course  the  free,  broad  smiles  upon  insufficient  occasion. 
There  was  a  certain  resistiveness  at  times,  though  whether 
Ardinian's  refusal  to  have  a  bath  on  entrance  should  be  re- 
garded as  suggestive  of  dementia  praecox  must  be  doubted. 
He  said  that  he  ought  not  to  be  compelled  to  do  anything  he 
did  not  want  to  do.  That  there  was  a  certain  delusional  trend 
seems  possible  if  not  probable.  The  government  had  not 
treated  him  right.  He  should  not  be  made  to  work  unless  he 
wanted  to.  On  being  asked  several  times  over  why  he  had 
refused  to  work,  he  replied  "me  too  much  work." 

It  seems  that  he  had  been  born  in  Armenia  twenty-five  years 
before;  that  one  brother  was  an  elevator  boy  at  the  hospital 
where  he  himself  had  worked,  and  that  another  was  in  Russia. 
He  had  worked  in  mills  as  a  laundry  helper.  He  had  once  gone 
back  to  Russia  and  come  around  the  world  in  returning.  He 
had  been  making  eleven  dollars  a  week.     When  he  had  first 


THE    KINGDOM    OF   EVILS  149 

come  to  Boston  he  had  been  remarkably  ambitious  and  went 
to  night  school  a  few  months  so  that  he  might  read  and  write 
English.  Although  he  was  better  coaxed  than  driven,  he  had 
never  shown  stubbornness  or  lost  his  temper  with  his  employer. 
On  the  other  hand,  it  appears  that  he  was  not  at  all  liked  by 
his  fellow  employees  as  he  was  rude  to  them  and  swore  at  them. 
On  the  whole,  he  was  inclined  to  keep  by  himself.  After  he 
brought  his  new  wife  back  from  Russia  his  employer  noticed 
a  change.  He  had  become  moody,  had  begun  to  tease  and  irri- 
tate other  workers  and  refused  to  do  anything  beyond  the  bare 
routine  of  his  job.  He  "did  not  feel  good,"  had  shaking  at- 
tacks at  night,  and  his  eyes  began  to  stare.  The  fact  that  his 
wife  was  still  working,  although  far  advanced  in  pregnancy, 
shamed  him  not  at  all. 

At  this  time  Armenians  of  the  neighborhood  arrested  him 
under  the  "work  or  fight"  law.  Ardinian  was  rather  care- 
fully examined  and  his  case  was  placed  before  two  staff  confer- 
ences at  the  Psychopathic  Hospital.  There  seemed  to  be  no 
doubt  that  he  was  a  victim  of  schizophrenia  (dementia  praecox) 
yet  the  disease  was  of  such  slight  degree  that  Ardinian  was 
not  at  first  regarded  as  committable.  It  was  thought  that  some 
kind  of  close  and  effective  social  supervision  might  encourage 
him  to  work.     Supervision  was  imperative,  however. 

The  fact  that  he  had  in  the  late  teens  or  early  twenties  been 
able  to  teach  school,  but  had  in  recent  years  lost  his  capacity 
to  do  more  than  such  work  as  dish-washing,  seemed  to  warrant 
the  assumption  that  there  had  been  a  slow-moving  loss  of 
mental  capacity  over  a  longer  period  than  recent  facts  indi- 
cated. In  short,  the  schizophrenia  process  may  have  been  going 
on  even  before  Ardinian's  marriage. 

Ardinian  showed,  under  social  treatment,  a  somewhat  pe- 
culiar attitude  to  work.  He  took  a  great  deal  of  interest  in 
the  occupational  worker  (a  graduate  of  one  of  the  courses  in 
occupational  therapy  established  for  war  work)  and  worked 
rather  effectively  at  weaving  for  her.  He  said  that  he  would 
work  to  please  her,  but  that  she  was  making  him  a  great  deal 
of  trouble.  The  moment  the  pilot  was  dropped,  so  to  speak, 
that  moment  he  refused  to  work  further.  There  was  thus  a 
sort  of  psychopathic  altruism  of  small  dimensions,  but  there 
was  no  ambition  or  effective  egoism  which  could  be  worked 


150  THE    KINGDOM    OF    EVILS 

on.  If  the  worker  said  "please"  to  him  he  replied  "do  not  say 
'please.'  If  you  say  'please'  I  have  to  make  and  I  cannot 
make." 

Ardinian  became  mildly  but  annoyingly  flirtatious  at  the 
end  of  three  months.  He  asked  his  wife  to  go  out  and  work 
for  him.  He  was  making  no  progress  in  work  for  himself. 
He  got  excited  at  times  and  even  struck  his  wife.  In  playing 
with  the  baby  he  swung  it  wildly  about. 

The  money  the  Ardinians  had  saved  was  now  practically 
exhausted  and  no  progress  was  likely  toward  immediate  cure 
or  self-support.  The  psychopathic  altruism  which  allowed 
Ardinian  to  work  a  little  on  the  immediate  suggestion  of  the 
worker  was  too  tenuous  to  build  upon  in  community  life.  That 
Ardinian  might  become  a  fair  worker  under  hospital  condi- 
tions was  possible.  The  answer  to  the  questions  on  this  case 
seemed  to  be  "commitment."  Ardinian  was  committed  four- 
teen weeks  after  he  left  the  hospital.  Looking  back  upon  this 
case,  one  might  wonder  whether  Ardinian  should  not  have 
been  committed  to  a  state  hospital  forthwith  upon  his  first 
period  of  observation.  There  was  no  change  in  the  medical 
diagnosis  during  the  fourteen  weeks  that  elapsed  between  hos- 
pital observation  and  eventual  commitment.  No  doubt  much 
time  now  proves  to  have  been  wasted  by  the  occupational 
worker,  who,  save  for  her  own  experience,  secured  nothing  in 
exchange  for  her  time,  either  for  the  world  at  large  or  for  the 
Ardinian  family  in  particular. 

The  problem  facing  the  court  in  a  case  like  Ardinian's  would 
be  exceedingly  difficult  if  there  were  not  adequate  social  super- 
vision available,  for  the  court  would,  on  the  one  hand,  not  be 
able  to  find  enough  in  Ardinian's  record  to  warrant  commit- 
ment. To  be  sure,  he  received  from  an  acute  medical  observer 
the  diagnosis  "dementia  praecox,"  but  this  would  not  in  itself 
indicate  commitment  forthwith.  On  the  other  hand,  the  ex- 
perienced court  would  bear  in  mind  numerous  cases  in  which 
mild  dementia  praecox  had  blossomed  into  exceedingly  dan- 
gerous excitement,  violence,  or  destructiveness.  Such  "waiting 
for  an  overt  act"  is  unfortunately  the  rule  in  sundry  communi- 
ties. Here,  with  the  proper  social  supervision,  there  was  less 
likelihood  that  the  advance  of  Ardinian's  process  would  go 
unobserved  and  catastrophes  would  very  probably  largely  be 
avoided. 


THE    KINGDOM    OF    EVILS  I5I 

IMeantime,  as  a  matter  of  social  technique,  the  social  care 
of  the  wife  and  arrangements  for  her  pregnancy  and  confine- 
ment and  for  her  offspring  were  carried  out  by  a  family  agency. 
Upon  his  commitment  the  family  was  then  turned  over  to  the 
family  agency  on  the  ground  that  the  psychiatric  part  of  the 
problem  had  been  removed  or  sufficiently  disposed  of. 

•\Ve  have  put  the  case  of  Ardinian  amongst  the  binary  com- 
binations and  classify  him  as  a  combination  of  medical  and 
le^al  difficulty.  The  medical  difficulty  we  have  sufficiently 
analyzed.  Legally.  Ardmian  came  to  an  arrest  and  was  com- 
mitted to  the  Psychopathic  Hospital  under  a  special  law  for 
observation.  He  was  thus  a  court  case  of  mild  mental  disorder 
whose  problem  got  its  solution  in  commitment  to  a  permanent 
receptacle  for  the  insane.  There  were  no  special  legal  compli- 
cations attending  this  commitment.  Had  Ardinian  committed 
some  overt  act  of  violence  or  destructiveness  before  his  first 
appearance  in  court  and  his  observation  at  the  Psychopathic 
Hospital,  no  doubt  he  would  have  been  forthwith  committed. 
His  mental  disease  was  such  a  peculiar  one  and  in  one  sense 
so  mild  at  the  outset,  that  this  solution  of  commitment  was  de- 
layed. In  the  long  history  of  legal  process,  however,  no  doubt 
we  may  think  of  Ardinian  as  a  relatively  simple  case  of  a  man 
arrested  under  the  "work  or  fight"  law  on  the  ground  of  be- 
havior for  which  he  was  quite  irresponsible. 

Hours  spent  by  ^iledical  record,  30  pages 

Social  record,  21  pages 
Physician,  5J/2  Social  work: 

Visits,  22 
Psychologist,  i  Interviews  at  hospital,  6 

Telephone  calls,  ^y 
Social  worker,  35  Letters,  7 


Intelligent  dothes-presser  disabled  by  occupational  neurosis. 
Large  family  in  Russia  to  support. 

Case  27.  Herman  Simonson  left  his  family  in  a  little 
village  of  Russia  ten  years  ago  and  came  to  iVmerica  to  advance 
his  fortunes.  He  lived  frugally  and  uprightly  and  was  a  man 
of  high  character  and  some  education.  The  work  he  found 
to  do,  clothes-pressing,  paid  good  wages,  but  yet  not  more  than 


152  THE    KINGDOM    OF    EVILS 

enough  to  keep  him  and  support  the  family  in  Russia — his 
wife,  six  daughters,  and  the  wife's  aged  parents.  As  the  years 
passed,  he  began  to  fear  that  he  could  not  earn  enough  to  bring 
them  over;  they  were  growing  restless  and  hard  feeling  began 
to  creep  into  their  letters. 

In  the  end  Simonson  acquired  a  severe  neurosis  with  pains 
in  the  legs  that  became  unbearable  when  he  worked  at  his  trade, 
and  deprived  him  of  strength  to  operate  his  pressing-machine. 
When  he  came  to  our  out-patient  department  he  had  been  the 
rounds  of  a  number  of  general  hospital  clinics  without  im- 
provement. His  legs  were  cold  and  blue  in  spite  of  the  five 
pairs  of  stockings  he  wore.  His  mental  state  was  one  of  utter 
despondency;  if  he  could  not  get  well  he  could  never  see  his 
children  again;  he  had  lived  for  them  and  now  they  had  not 
enough  to  eat  in  that  little  Russian  village  and  he  could  earn 
nothing  to  send  them ;  would  it  not  be  best  for  him  to  commit 
suicide  while  his  life  insurance  was  paid  up?  H  he  could  not 
be  cured,  almshouse  life,  never  to  see  his  wife  or  children 
again,  was  a  fate  tragic  enough.  He  was  cured  after  three 
years  of  persistent  work.  He  first  and  last  resisted  treatment, 
wanted  to  try  another  doctor,  objected  to  every  kind  of  light 
work  suggested  and  found  fault  with  everything  the  social 
workers  did  for  him,  but  was  restored  to  competency,  one  might 
say,  in  spite  of  himself. 

It  was  decided  that  the  best  prospect  of  making  the  patient 
self-supporting  lay  in  setting  him  up  in  business  in  a  small 
store,  and  a  sum  of  money  was  raised  for  this  purpose.  After 
many  attempts  to  find  a  store  that  would  be  a  safe  investment, 
an  opportunity  for  trading  in  coal  was  arranged.  Meanwhile 
a  number  of  temporary  occupations  were  tried,  which  the 
patient  would  give  up  after  a  brief  effort.  He  was  under  treat- 
ment as  an  out-patient  continually,  and  for  six  weeks  was  in 
the  hospital  as  a  voluntary  patient.  He  complained  that  the 
doctors  did  not  help  him ;  thought  that  the  lodge  members  who 
were  obtaining  financial  support  for  him  were  adding  to  their 
reputation  as  charitable  individuals  by  helping  him ;  claimed 
that  the  money  raised  for  him  belonged  to  him  and  sb.ould  be 
given  to  him  unconditionally ;  repeatedly  said  he  suffered  "every 
minute  of  the  day"  but  had  not  the  courage  to  kill  himself, 
though  he  would  if  it  were  not  for  his  children. 

As  the  pains  in  the  legs  decreased  and  he  admitted  feeling 


THE    KINGDOM    OF    EVILS  153 

better,  we  insisted  that  he  take  a  position  as  porter  in  a  small 
factory  in  order  to  prevent  his  becoming  completely  disused  to 
work.  This  was  a  job  that  he  considered  beneath  him,  and 
it  paid  only  ten  dollars  a  week,  but  it  was  the  only  thing  open 
that  he  could  do.  He  still  holds  on  to  this  job  at  higher  wages, 
although  he  has  since  developed  the  coal  business.  In  the  fac- 
tory he  is  regarded  as  a  man  who  must  be  humored,  for  every- 
body near  him  must  hold  his  opinion  or  none.  The  foreman 
sums  him  up,  "Well,  you  know,  he's  Simonson !"  He  has 
been  elected  president  of  a  benefit  organization  to  which  he 
belongs.  He  is  said  to  be  "as  cranky  as  ever"  but  is  alert  and 
in  good  spirits. 

We  analyze  Herman  Simonson  as  a  binary  combination  of 
medical  and  economic  disorder.  W^e  regard  him  medically  as 
belonging  to  the  psychoneurotic  group  of  disorders.  His  fleet- 
ing pains,  his  rounder's  history  in  several  hospitals  without 
relief,  and  his  constipation  were  features.  Whilst  in  hospital 
he  woke  up  five  or  six  times  in  the  night  worrying  about  his 
family  in  Russia.  He  felt  cold  sensations  in  the  legs  and 
sometimes  had  prickling  sensations  in  the  calves  of  both  legs. 
Sometimes  his  hands  were  overwarm  and  sweating.  He  com- 
plained of  a  bad  headache.     He  was  neurologically  normal. 

The  impression  which  Simonson  conveyed  to  the  physicians 
was  one  of  relatively  hopeless  psychoneurosis.  Accordingly, 
when  it  proved  possible  to  get  several  hundred  dollars  to  set 
Simonson  up  in  business  there  was  considerable  concern  ex- 
pressed by  the  physicians  lest  the  money  was  being  thrown  into 
the  sea.     The  results  above  described  speak  for  themselves. 

It  is  worthy  of  particular  medical  inquiry  whether  there  is 
any  adequate  and  obvious  physical  cause  for  such  a  psycho- 
neurosis  as  Simonson's.  Cases  numerous  enough  in  this  col- 
lection yield  no  such  physical  cause,  but  the  failure  to  find  such 
on  the  surface  does  not  mean  that  such  may  not  really  exist. 
Moreover,  there  may  be  a  kind  of  psychoneurosis  due  to  spe- 
cial physical  causes  working  directly  or  indirectly  upon  the 
mind.  Thus  in  Simonson's  case  it  may  be  inquired  whether 
the  steady,  hard  work  and  confining  work  at  clothes-pressing 
with  its  persistent  cramped  postures  may  not  have  worked 
after  the  manner  of  the  so-called  occupation  neurosis.  The  best 
example  of  occupation  neurosis  is,  of  course,  the  familiar 
writer's  cramp,  but  even  in  writer's  cramp  there  is  an  admix- 


154 


THE    KINGDOM    OF    EVILS 


ture  of  physical  with  psychic  conditions,  a  mixture  not  always 
easy  to  analyze. 

Some  authorities  who  have  gone  very  deeply  into  the  mat- 
ter of  occupational  neurosis  find  physical  causes  in  not  a  few. 
We  give  below  a  partial  list  of  occupations  which  have  given 
rise  to  occupation  neurosis  (Southard  and  Solomon  in  Kober 
and  Hanson's  Diseases  of  Occupation  and  Vocational  Hygiene, 
1916) 


Auctioneer 

BicycHst 

'Cellist 

Cigar-roller 

Clarionetist 

Compositor 

Cornetist 

Dancer 

Diamond-cutter 

Enameler 

Engraver 

Flower-maker 

Flutist 

Gold-worker 

Hammerman 

Harpist 

Knitter 

Laborer 


Lathe-turner 

Letter-sorter 

Lithographer 

Locksmith 

Mason 

Microscopist 

Milker 

Miner's  nystagmus 

Money-counter 

Nail-maker 

Organist 

Painter 

Pianist 

Preacher 

Sailor 

Sawyer 

Scissors-sharpener 

Seamstress 


Sewing-machinist 

Shaver 

Shoemaker 

Singer 

Smith 

Tailor 

Tawer 

Telegrapher 

Tennis-player 

Tinker 

Trap-drummer 

Treadler 

Trumpeter 

Turner 

Walker 

Watchmaker 

Zitherist 


Hours  spent  by 
Physician,   55^-2 
Psychologist,  0 
Social  worker,  35 


Medical  record,  18  pages 
Social  record,  22  pages 
Social  work : 

Visits,  15 

Interviews  at  hospital,  14 

Telephone  calls,  15 

Letters,  12 


Series  of  feigned  suicides.  Psychopathic  girl  who  desired 
to  be  some  sort  of  heroine. 

Case  28.  Aimee  Prevost  stands  on  the  Psychopathic  Hos- 
pital books  as  a  psychopathic  personality.  Her  history,  with 
its  series  of  feigned  suicides,  some  of  them  most  neatly  staged, 
is  possibly  in  some  sense  a  history  of  instincts  unchecked. 
Aimee  constantly  saw  herself  in  other  people's  eyes  and  re- 


THE    KINGDOM    OF   EVILS  155 

lentlessly  tried  a  variety  of  expedients  to  succeed.  The  desire 
to  be  some  sort  of  heroine  was  Aimee's  desire.  We  confess  to 
some  hesitation  in  taking  all  such  as  psychopathic!  In  any 
event,  we  have  classified  her  as  virtually  non-medical  in  her 
display  of  troubles  and  have  regarded  her  as  a  combination  of 
educational  and  moral  difficulty. 

When  Aimee  first  appeared  on  the  hospital  scene,  she  seemed 
rather  illiterate.  In  due  time  she  was  examined  psychologically 
on  four  different  occasions,  at  periods  about  a  year  apart.  It 
was  clear  from  the  examinations  that  she  was  not  feeble-minded 
and  had  good  native  ability,  yet  in  all  four  examinations  the 
variability  of  her  attention  and  her  lack  of  effort  in  carrying 
out  the  tests  were  striking.  So  far  as  the  mental  tests  went, 
her  difficulties  looked  in  the  general  direction  of  a  disorder  of 
the  will. 

If  we  choose  to  disregard  the  vague  aspects  of  psychopathy 
in  the  Prevost  case,  we  shall  see  her  problem  as  virtually  the 
combined  problem  of  reeducation  intellectually  and  retraining 
morally.  The  legal  contacts  and  even  the  economic  problems 
remain  minor. 

Aimee  Prevost  was  the  oldest  of  four  children  in  a  French 
Canadian  family  living  in  a  Massachusetts  town.  By  the  time 
she  was  eight  years  old  both  parents  had  gone  to  hospitals  for 
the  insane  in  Canada,  and  the  children  were  scattered.  Aimee 
went  to  live  with  an  aunt.  At  sixteen  she  was  working  in  a 
mill  in  another  city  and  had  begun  her  life  of  independence 
with  little  or  no  knowledge  of  her  family.  She  came  to  Boston 
at  seventeen  and  worked  for  periods  from  a  few  weeks  to  sev- 
eral months  in  hotels,  restaurants,  and  hospitals. 

She  was  twenty  when  we  first  knew  her  in  191 3.  A  pre- 
tended attempt  at  suicide  brought  her  to  the  Psychopathic  Hos- 
pital. She  had  taken  iodine  and  then  gone  to  the  police  for 
safety,  no  doubt  reassured  by  a  similar  experience  six  months 
before  when  she  had  sought  the  police  after  drinking  chloro- 
form liniment.  Some  months  before  she  had  swallowed  a 
corrosive  tablet  in  the  presence  of  a  medical  student,  who  had 
carried  her  to  an  emergency  hospital  for  treatment.  She  now 
said  that  she  was  despondent  because  this  same  student,  who 
had  lived  with  her  as  his  wife,  and  whom  she  had  expected 
to' marry  her,  had  left  her.  She  said  that  she  would  "get  re- 
venge if  it  should  take  ten  years."     She  had  already  written 


156  THE    KINGDOM    OF    EVILS 

with  vindictive  intent  to  his  father  and  a  girl  he  knew  at 
home. 

When  Aimee  left  the  hospital  the  social  service  undertook 
supervision.  She  was  a  likable  girl  with  a  certain  sweetness 
of  disposition  in  her  good  moods,  and  with  ability  to  reason 
intelligently.  She  had  a  rather  touching  desire  for  refined 
and  attractive  surroundings  and  surprising  discrimination  in 
recognizing  educated  tastes  and  manners.  She  prided  herself 
upon  holding  a  reputation  for  always  having  "classy  fellows," 
and  was  never  without  one  or  more  students  to  take  her  about. 
Her  desire  for  "good  times"  was  insatiable.  Although  the  ex- 
tent of  her  sex  delinquencies  could  never  be  learned,  by  her 
own  admission  they  were  many.  She  had  had  two  gynecolog- 
ical operations  during  the  last  three  years,  and  was  even  now 
in  need  of  treatment  for  gonorrhea.  The  blood  test  for 
syphilis  was  positive. 

It  was  clear  that  the  girl  had  had  a  poor  chance  in  life,  and 
she  herself  felt  bitter  about  her  lack  of  opportunity.  She  said 
she  wanted  "to  take  a  fresh  start"  and  to  try  with  help  pro- 
vided by  the  social  service  "to  make  something  of  herself."  A 
comprehensive  program  was  planned,  for  work,  recreation,  a 
church  connection  through  a  sympathetic  priest,  treatment  for 
gonorrhea,  and  a  good  boarding  place.  The  social  workers 
saw  her  frequently.  Attempts  to  find  recreation  to  compete 
with  the  "good  times"  of  the  past  fell  flat.  Jobs  were  found 
and  at  once  lost  through  the  girl's  incompetency.  "We  don't 
want  her  type  of  girl,"  the  report  would  be.  She  ignored  the 
church,  found  excuses  for  not  Hving  in  the  boarding  places 
chosen,  and  neglected  her  treatments.  She  refused  to  go  into 
an  industrial  school,  to  which  there  was  no  way  of  committing 
her  against  her  will.  Untrained  for  any  work  that  might  ap- 
peal to  her  intelligence  and  satisfy  her  ambition,  she  was 
despondent  because  she  had  "no  future."  So  after  a  few 
months  it  was  arranged  for  her  to  attend  a  trade  school.  Her 
board  was  paid  by  a  friend  of  the  social  worker,  who  had  had 
experience  with  girls  in  similar  plights  and  undertook  to  help 
in  the  reeducation  of  Aimee.  For  a  few  weeks  she  was  happy, 
but  her  work  proved  unsatisfactory,  and  in  the  second  month 
she  gave  it  up.  A  commercial  school  was  tried  (to  learn  type- 
writing and  the  use  of  the  billing  machine)  and,  when  she  was 
discharged   for  f^oor  work  itnd  bad  conduct,  a  second  school 


THE    KINGDOM    OF    EVILS  157 

was  tried  with  the  same  resuh.  "She  made  almost  no  prog- 
ress, and  was  inattentive  and  troublesome,  taking  other  stu- 
dents' attention  and  not  following  rules  or  instructions.  Her 
personal  appearance  was  much  against  her,  as  she  was  untidy 
as  well  as  painted."  The  three  school  attempts  covered  a  year. 
Meanwhile  Aimee  had  improved  a  good  deal  in  appearance 
and  manners.  She  took  better  care  of  her  clothes  and  person, 
although  she  was  still  rather  inclined  to  be  dirty.  She  had  a 
series  of  admirers,  and  "good  times"  continued.  She  was  asked 
to  leave  the  girls'  lodging  house  where  she  had  been  placed  be- 
cause she  was  "a  bad  influence  on  the  girls." 

Aimee  had  now  to  look  again  for  an  uncongenial  job.  She 
was  discouraged  and  unhappy,  and  wanted  to  be  with  her  own 
people.  A  sister  had  been  located,  well  married  and  living  in 
comfortable  circumstances  in  a  rural  neighborhood  in  Canada. 
Aimee  was  sent  to  visit  her.  After  a  few  days  her  brother- 
in-law  in  righteous  indignation  turned  her  out  of  his  home  and 
found  her  a  refuge  in  the  almshouse.  We  brought  her  back 
and  found  her  a  position  at  housework. 

Soon  she  announced  that  she  was  to  be  married  to  a  college 
senior,  the  son  of  wealthy  parents  from  another  state.  The 
boy  came  at  once  in  response  to  a  letter  asking  him  to  call  and 
said  he  did  intend  to  be  married  to  Aimee,  and  that,  although 
he  had  believed  that  he  was  the  first  man  to  have  sexual  inter- 
course with  her,  he  did  not  think  the  knowledge  that  he  was 
not  would  miake  any  difference.  He  said  that  he  was  willing  to 
"break  it  off,"  but  Aimee  seemed  so  unhappy  at  the  idea  of  his 
leaving  her  that  he  felt  he  ought  to  marry  her,  though  he  did 
not  exactly  love  her.  He  was  a  fine-looking  lad  with  nice  man- 
ners. Learning  that  he  was  about  to  leave  town,  Aimee  had 
him  arrested  for  breach  of  promise,  but  agreed  to  drop  the  case 
under  advice  from  the  boy's  lawyer.  In  compensation  his 
father  gave  her  five  hundred  dollars,  and  she  fitted  herself  out 
at  once  with  new  clothes  in  remarkably  good  taste.  The  young 
man  on  release  from  jail  went  directly  to  her  room  and  spent 
the  night  with  her,  again  offering  to  marry  her.  He  departed, 
however,  and  Aimee  followed  him  to  New  York  and  threatened 
to  bring  another  suit.  But  she  came  back  and  arranged  the 
most  dramatic  of  her  suicidal  episodes.  She  left  by  the  river 
bank  an  old  hat  and  coat  with  a  note  to  the  hospital  saying  that 
she  would  be  drowned  when  it  was  received,  and  later  leturned 


158  THE    KINGDOM    OF    EVILS 

to  the  spot  to  join  the  crowd  watching  the  river  dragged.  Two 
days  later  the  poHce,  who  had  been  notified,  found  her  draw- 
ing the  last  of  her  five  hundred  dollars  from  the  bank  and 
brought  her  to  the  hospital.  She  was  amused  by  the  success 
of  her  "frame-up,"  and  somewhat  consoled  for  the  loss  of  her 
lover  by  the  newspaper  notoriety  she  had  gained,  but  she  still 
swore  vengeance  upon  him. 

After  this  Aimee  refused  to  keep  in  touch  with  us  and  we 
felt  that  our  supervision  would  alter  but  little  the  course  of 
her  life.  She  was  clever  enough  to  find  work  and  make  friends 
and  to  keep  out  of  court.  The  life  of  the  professional  prosti- 
tute disgusted  her  and  she  would  probably  continue  to  have 
promiscuous  sex  relations  of  a  private  nature  and  to  work 
intermittently. 

We  heard  of  her  six  months  later  as  nurse  in  training  in  a 
hospital  for  mental  diseases  in  another  state.  A  social  worker 
there  who  had  known  her  said  that  she  was  doing  well  in  her 
work  and  seemed  greatly  changed.  She  appeared  ambitious  to 
lead  a  regular  life  and  intelligently  interested  in  her  work.  But 
soon  she  gave  up  the  training  and  left  claiming  that  she 
was  afraid  her  history  would  be  known,  since  she  had  been 
recognized. 

Hours  spent  by  Medical  record,  33  pages 

Social  record,   51   pages 
Physician,  9  Social  work : 

Visits,  35 
Psychologist,  4  Interviews  at  hospital,  61 

Telephone  calls,  91 
Social  worker,  100  Letters,  75 


Portuguese  ivho  got  into  a  tangle  over  his  draft  papers  and 
was  arrested  for  "desertion."     Epilepsy. 

Case  29,  We  found  it  hard  to  get  a  good  example  of 
the  binary  combination  of  educational  and  legal  troubles.  It 
actually  seems  as  if  this  particular  dyad  of  evils  is  statistically 
very  infrequent.  At  all  events  this  is  true  for  the  Psychopathic 
Hospital  group  of  cases.  Yet  if  we  think  of  the  matter  in  the 
most  general  way,  can  the  world  be  otherwise  built  than  to 
show  many  instances  of  persons  who  through  ignorance  are 
unable  to  cope  with  legal  difficulties?     Naturally,  plain  com- 


THE    KINGDOM    OF    EVILS  I59 

binations  of  educational  and  legal  difficulty  without  psycho- 
pathic or  moral  twists  would  not  in  the  first  instance  get  to  the 
Psychopathic  Hospital  clinic. 

The  Portuguese,  John  Manaos,  whom  we  choose,  was  a 
man  of  about  thirty  years,  who  may  have  been  somewhat 
feeble-minded,  though  there  is  no  definite  evidence  of  this. 
He  could  speak  English,  but  spoke  it  very  imperfectly.  Though 
he  had  forgotten  most  of  his  Portuguese,  he  was  fairly  well 
Americanized.  Yet  he  got  into  a  tangle  concerning  draft 
papers  in  connection  with  his  war  service  and  apparently  quite 
through  ignorance  was  unable  to  straighten  out  the  techni- 
calities. He  was  arrested  and  put  in  a  guardhouse  for  failure 
to  fill  out  his  draft  paper.  The  fact  was  that  he  had  really  filled 
out  a  draft  paper  and  returned  it.  A  second  blank  was  given 
him  which  he  returned,  saying  that  he  had  already  filled  out  a 
blank.    Thereafter  came  the  arrest,  technically  for  "desertion." 

At  the  police  station  he  began  to  show  a  psychosis.  In  the 
midst  of  normal  talk  with  his  relatives  he  would  all  of  a  sud- 
den become  mute  and  tense,  staring  fixedly  at  the  wall.  He  was 
tense  and  staring  on  admission  to  the  Psychopathic  Hospital 
and  was  very  resistive  during  the  process  of  undressing.  He 
said  he  had  been  in  the  hospital  ten  minutes  and  immediately 
afterwards  said  that  he  had  been  there  all  night.  When  asked 
the  date  he  said  "January  5,  era  first  year,  that  is  what  they 
keep  saying."  He  told  of  having  fainting  spells  every  week 
with  loss  of  consciousness.  Something  dropped  in  his  throat, 
he  said.  At  other  times  he  had  been  unable  to  talk.  He  said, 
"My  mind  is  getting  blank."  He  had  had  influenza  about 
three  weeks  before  admission.  His  eyes  were  somewhat  prom- 
inent, hands  tremulous,  and  his  knee  jerks  hyperactive. 

Under  observation  he  was  at  times  overactive  and  talkative, 
at  times  quiet  and  mute,  at  times  hallucinated  (women  were 
talking  about  him  and  voices  called  his  name).  After  about 
ten  days  he  became  pretty  clear  and  began  to  take  an  interest 
in  time,  place,  and  persons.  Asked  about  his  phrase  concern- 
ing the  new  era,  he  said :  "They  say  the  world  is  changing. 
They  were  talking  amongst  themselves.  There  was  the  first  era, 
the  Babylonian,  Syrian,  and  Greek.  I  thought  this  was  going 
to  be  the  German  or  something  like  that,  you  know."  About 
this  time  he  seemed  a  case  not  only  committable  but  deserving 
commitment  forthwith.     He  was  accordingly  committed  Feb- 


l60  THE    KINGDOM    OF    EVILS 

ruary  5  (about  three  weeks  after  admission),  but  was  suffi- 
ciently well  to  be  dismissed  about  seven  weeks  after  admission 
in  a  condition  "improved."  The  diagnosis  was  epileptic  psy- 
chosis (clouded  state). 

Like  so  many  psychopaths  of  various  sorts,  Manaos  had 
the  reputation  of  being  a  nervous  and  delicate  fellow.  His 
work  record  was  studied  rather  intensively  by  a  worker  em- 
ployed in  industrial  researches,  and  we  therein  find  a  history 
of  many  jobs  dropped  for  a  variety  of  reasons,  no  one  of  them 
particularly  suspicious  of  psychopathy,  yet  taken  on  the  whole 
suggestive  of  general  inadequacy.  In  less  than  three  years  he 
had  worked  in  ten  different  places  as  porter,  car-cleaner,  kitchen 
boy,  milling-worker,  machinist's  helper,  etc.  Manaos  had  the 
idea  of  being  a  machinist.  The  bare  record  of  condensed  en- 
tries concerning  the  various  jobs  and  the  periods  spent  on  them 
during  the  last  three  years  fill  five  typewritten  pages. 

A  record  was  found  of  his  having  been  arrested  as  idle 
and  disorderly  for  hanging  about  street  corners  at  the  age  of 
twenty.  The  difficulty  again  seems  to  have  been  one  of  igno- 
rance rather  than  of  any  moral  defect.  Of  course,  the  hypothe- 
sis might  be  raised  that  he  was  already  epileptic  at  that  time, 
and  if  we  felt  that  these  episodes  of  arrest  for  idleness  and  for 
"desertion"  were  really  arrests  of  a  man  who  was  in  a  clouded 
state  of  mind,  then  we  should  perforce  have  to  regard  Manaos 
not  as  a  combination  of  ignorance  and  legal  trouble  but  as  a 
combination  of  disease  and  legal  trouble.  After  giving  due 
prominence  to  the  hypothesis  of  epilepsy  and  its  accompanying 
clouded  states  as  a  cause  of  Manaos's  difficulties,  we  are  still 
inclined  to  think  that  he  is  a  man  who  could  be  and  can  be 
taught  to  do  much  better.  For  example,  he  was  once  employed 
as  a  night  watchman.  The  owner  found  him  sitting  with  his 
lantern  on  a  curbstone  outside.  Upon  being  told  that  this  was 
not  proper  watching,  Manaos  was  thereafter  (so  long  as  em- 
ployed) a  perfectly  good  watchman.  He  had  not  been  a  stupid 
boy  at  school.  He  had  started  school  late  and  left  it  at  the  age 
of  fifteen  in  the  eighth  grade. 

This  is  of  course  a  case  whose  outcome  cannot  be  stated. 
Many  epileptics  remain  in  this  community  doing  perfectly  good 
work  throughout  their  lives.  Indeed,  there  are  no  doubt  many 
epileptics  who  accomplish  unusual  things  and  are  actually  emi- 
nent men.     This  Portuguese  was  actually  committed  (although 


THE    KINGDOM    OF    EVILS  l6l 

released  after  a  few  days)  as  a  victim  of  epileptic  psychosis, 
and  it  may  be  thought  that  he  will  finally  be  committed  once 
more.  In  the  intervals,  however,  aside  from  the  persistence 
for  a  few  hours  or  days  of  a  clouded  state,  Manaos  is  to  our 
minds  much  more  of  an  educational  than  a  medical  problem. 

A  community  that  should  elaborate  its  mental  hygiene  to  the 
last  point  would  no  doubt  devise  a  means  for  light  and  non-dis- 
turbing contact  with  Manaos  for  a  period  of  many  years  and 
no  doubt  the  entire  cost  of  such  mental  hygienic  measures 
w^ould  be  amply  compensated  for  by  the  preserving  of  another 
industrial  life  from  undue  interference  either  by  his  lack  of 
information  or  by  the  complications  of  epilepsy. 

For  a  further  account  of  epileptic  phenomena,  see  Section 
III  in  Book  III. 

Hours  spent  by  Medical  record,  ii  pages 

Social  record,  ii  pages 
Physician,  6^4  Social  work: 

Visits,  II 
Psychologist,  o  Interviews  at  hospital,  4 

Telephone  calls,  9 
Social  worker,  23J/2  Letters,  7 


Overworked  young  mother  harassed  by  scolding  husband. 

Case  30.  Emma  Marburg  came  to  the  out-patient  depart- 
ment by  the  advice  of  another  patient  because  she  felt  she 
would  not  "be  able  to  hold  out  much  longer."  She  had  married 
at  seventeen  John  Marburg,  a  Pole,  ten  years  older  than  her- 
self, and  had  never  been  happy  with  him.  She  was  now  twenty- 
six  and  had  five  children.  The  family  lived  in  three  dark 
rooms  at  the  back  of  a  ground  floor  tenement.  Mr.  Marburg 
had  earned  only  ten  dollars  a  week  as  a  mechanic  until  recently 
when  he  began  to  make  fifteen  to  nineteen  dollars  a  week.  He 
had  kept  out  of  debt  and  his  wife  even  suspected  him  of  having 
some  small  savings;  but  as  the  weekly  expenses  for  mainten- 
ance were  between  sixteen  and  seventeen  dollars  a  week,  their 
life  was  a  struggle  for  existence.  A  legacy  of  several  hundred 
dollars  from  Mrs.  Marburg's  father  a  few  years  earlier  had 
helped  out. 

Mrs.    Marburg  was   frail   and   lacked  vitality.      Her  chief 


l62  THE    KINGDOM    OF    EVILS 

symptoms  according  to  the  medical  record  were  "fatigue,  un- 
happiness,  and  worry."  She  felt  hopeless  about  her  ability  to 
give  the  children  proper  care,  and  was  terrified  at  the  thought 
of  having  more  children.  She  had  lost  all  ambition  to  keep  the 
house  in  order  (it  was  unspeakably  disorderly  and  filthy),  for 
their  tenement  was  unwholesome  and  even  the  necessary  house- 
hold utensils  were  lacking.  More  fundamental  than  this  ma- 
terial resourcelessness  was  the  poverty  of  her  relations  with 
her  husband,  a  man  of  good  but  peculiar  disposition.  He  had 
always  "nagged  her"  and  quarreled  with  her,  complaining  of 
the  disorder  of  the  house  and  the  poor  quality  of  the  food,  and 
blaming  her  for  having  so  many  children,  which  he  attributed 
to  "her  laziness."  He  suspected  her  of  relations  with  other 
men  (without  justification)  and  a  year  before  had  openly 
accused  her  of  sex  relations  with  the  godfather  of  one  of  the 
babies,  who  left  the  house  and  never  returned.  He  seemed 
afraid  of  his  wife :  at  night  he  would  bolt  the  door  of  his  bed- 
room, he  would  make  the  children  taste  the  food  before  he  ate, 
would  move  away  if  she  came  near,  and  look  around  if  she 
passed  behind  him.  At  one  time  he  complained  to  a  children's 
agency  that  she  neglected  the  children.  No  action  was  taken, 
but  Mrs.  Marburg  was  deeply  mortified,  as  she  said  she  had 
always  tried  to  do  her  best  by  the  children  and  stayed  with  her 
husband  only  on  their  account. 

Mr.  Marburg  had  come  to  our  out-patient  department  three 
years  before  complaining  of  "nervousness  and  sleeplessness." 
The  examination  showed  no  evidence  of  mental  defect  or  psy- 
chosis ;  and  his  symptoms  were  attributed  to  excessive  use  of 
coffee  and  tobacco. 

The  marital  discord  seemed  to  center  around  the  question 
of  thrift.  Mr.  Marburg  came  of  a  family  of  frugal,  successful 
workmen  and  his  mother  had  kept  a  clean,  comfortable  house  in 
Austria.  Both  he  and  his  brother  were  disappointed  in  the  bad 
housekeeping  of  their  American  wives.  Marburg  wished  to 
live  well  and  also  to  save  money.  He  wanted  his  wife  to  take 
lodgers,  and  to  go  out  and  work  to  earn  stil!  more  money.  He 
could  not  understand  her  refusal  nor  her  inability  to  give  him 
nourishing  food  and  provide  a  clean  home  with  the  ten  dollars 
a  week  he  gave  her.  He  was  fond  of  the  children  and  helped 
at  times  with  their  care;  and  he  was  fond  of  his  wife  to  the 
extent  of  saying  that  he  could  care  for  no  other  wom.an,  but 


THE    KINGDOM    OF    EVILS  163 

he  said  that  "the  man  must  come  first"  and  he  was  not  so  much 
worried  by  the  fact  that  the  children  were  thin  and  undernour- 
ished and  the  failure  of  his  ambitions  to  have  "a  good  home" 
as  he  was  by  his  inability  to  save.  He  was  the  only  well-fed 
member  of  the  family.  Yet  he  was  a  well-meaning  man  and 
sincerely  troubled  about  the  state  of  his  family  affairs.  He 
had  been  many  times  to  his  physician  with  his  tale  of  woe, 
until  he  had  become  "a  pest."  He  offered  to  pay  a  fee  for  these 
social  calls,  which  was  not  accepted,  and  finally  the  physician 
had  to  refuse  to  see  him. 

Mrs.  Marburg  had  not  had  a  happy  life  up  to  the  time  of 
her  marriage  at  seventeen.  Her  mother  died  when  she  was  a 
baby  and  her  stepmother  was  unkind  to  her  and  her  sister  and 
fed  them  scantily,  for  the  most  part  on  bread  and  tea.  She  was 
kept  out  of  school  to  help  at  home,  so  that  when  she  was  taken 
out  of  school  at  fourteen  to  be  put  to  work  she  was  in  the 
seventh  grade.  She  graded  well  in  the  psychological  examina- 
tion. After  three  years  in  a  rubber  factory  she  married  to  get 
rid  of  the  "nagging"  at  home.  Six  years  later  her  father  com- 
mitted suicide. 

The  social  problem  here  was  one  ot  educational  and  financial 
deficiency,  an  untrained  woman  with  an  income  insufficient  for 
the  needs  of  her  family,  li  Mrs.  Marburg  could  be  taught 
good  standards  of  living  and  educated  in  good  housekeeping 
and  sufficient  funds  could  be  provided  to  maintain  the  family 
suitably,  it  seemed  probable  that  there  would  be  no  medical  dif- 
ficulty, and  that  the  marital  dissension  would  subside  to  a  nor- 
mal level.  No  question  of  conflict  with  public  authorities  ever 
arose  in  this  case.  Our  efforts  were  directed  then  toward  the 
better  education  of  Emma  Marburg  and  a  more  provident  use 
of  John's  wages.  In  time  he  should  be  earning  more.  Al- 
though he  sought  to  give  the  impression  that  he  had  saved  a  few 
hundred  dollars,  it  was  pretty  sure  that  he  had  only  about  sev- 
enty-five dollars  stored  away. 

The  first  steps  toward  this  end  were  to  secure  John's  sym- 
pathy and  cooperation,  which  he  yielded  fairly  readily,  with 
occasional  changes  of  mind ;  to  keep  Emma's  courage  up ;  and 
to  rally  around  the  family  the  friendly  interest  of  relatives, 
physicians,  teachers,  and  priest.  A  new  tenement  was  found, 
whereupon  Mr.  Marburg  committed  the  extravagance  of  fur- 
nishing a  parlor  in  mission  style,  a  hopeful  sign  we  felt  in  a 


164  THE    KINGDOM    OF    EVILS 

man  with  habits  of  excessive  thrift.  Some  gifts  of  household 
goods  and  clothing  were  used  to  cheer  Mrs.  Marburg.  There 
was  not  enough  clothing  in  the  house  to  dress  all  the  children 
completely  at  the  same  time  and  Mrs.  Marburg's  apparel  was 
depressingly  shabby.  The  children  were  taken  to  a  hospital  for 
examination,  and  a  tonsil  operation  was  performed  upon  four 
of  them.  The  baby's  feeding  was  regulated  also.  After  tre- 
mendous efforts  to  overcome  Mr.  Marburg's  opposition  to  the 
novelty  of  the  idea,  Emma  was  sent  to  a  convalescent  home  for 
a  four  weeks'  vacation,  while  the  children  were  boarded.  In- 
cidentally she  acquired  some  housekeeping  notions  and  brought 
back  a  sheaf  of  recipes.  A  visiting  housekeeper  was  secured 
to  undertake  her  instruction.  Unfortunately  one  of  the  chil- 
dren brought  home  an  infection  of  scabies  which  ran  through 
the  family  and  interrupted  education ;  and  Emma  was  laid  up 
with  a  scalded  foot.  Then  came  the  discovery  that  she  was 
again  pregnant.  In  spite  of  the  terror  she  had  shown  when 
she  first  came  to  us  a  year  before,  she  accepted  the  fact  calmly. 
She  had  become  somewhat  happier  and  more  reconciled  to  her 
husband,  who  showed  a  very  much  better  disposition  and  took 
more  responsibility  for  making  the  home  comfortable.  He  had 
an  occasional  relapse  into  his  scolding  habits,  but  on  the  whole 
had  become  fairly  considerate.  The  case  was  left  in  the  care 
of  a  prenatal  clinic.  We  felt  that  at  least  another  year  of  inten- 
sive social  treatment  would  be  required  to  effect  any  lasting 
improvement  in  so  deep-seated  a  case  of  ignorance  and  povertv, 
but  we  could  not  carry  the  case  longer  because  (according  to 
prevailing  custom)  our  staff  of  social  workers  is  not  large 
enough  to  carry  one-half  of  the  current  work  of  the  hospital, 
and  urgent  and  acute  cases  demand  for  the  most  part  first 
attention. 

Hours  spent  by  Medical  record,  9  pages 

Social  record,  39  pages 
Physician,  434  Social  work  : 

Visits,  62 
Psychologist,  l  Interviews  at  hospital,  6 

Telephone  calls,  18 
Social  worker,  100  Letters,  12 


SYPHILITIC  DELINQUENT— I 
GIRL,  21 

1915 

Poor  Stock  (Alcohol,  Sex  Delinquency) 
Placed  Out,  3   (Troublesome) 
Kidnapped  Home,   12   (Incest) 
Reform  School,  13   (Good  Work) 
Parole,  18  (Lewdness,  Temper,  Blues) 
Suicidal  Attempts 

(syphilis  congenital?) 


SYPHILITIC  DELINQUENT— II 

GIRL,  21-24 

ipiyiQiS 

Good  Work  at  a  Job  but — 
Unmanageable 

Suddenly  Married  a  Black  Sheep- 
Kept  House  Well 

Baby  Took  a  Prize 

Illness — in  Hospital 

Discord 

Another  Baby  Sick 

Husband  in  Prison — Paroled 

Third  Pregnancy 

Improvement  Under  In-Law's  Care! 


Wayward,  syphilitic  girl  married  to  a  black  sheep.  In  the 
end  a  devoted  mother. 

Case  31.  Alice  Nardini,  an  American  girl  of  twenty-one, 
married  in  haste  to  Joseph  Nardini,  an  Italian  youth  about  her 
own  age  (the  "black  sheep"  of  a  good  family)  is  presented  as  a 
case  whose  outstanding  features  were  moral  and  legal.  She 
had  received  a  fair  education,  and  although  her  early  training 
was  of  the  poorest,  a  term  in  an  industrial  school  had  taught 
her  the  essentials.  Financially  she  could  always  "get  along" 
although  fairly  near  the  margin  of  poverty.  Strictly  speaking, 
she  was  not  without  medical  difficulties  (presumably  every  case 
under  care  at  the  Psychopathic  Hospital  has  some  medical 
complication),  but  the  positive  Wassermann  test  probably  due 
to  congenital  syphilis  and  the  psychopathic  aspect  of  her  quick- 
tempered, moody  disposition  were  less  conspicuous  in  her  case 
than  her  unreliable  conduct.  Legal  complications  appear  from 
time  to  time.  She  seems  to  be  one  of  those  persons  who  are 
always  on  the  verge  of  association  with  the  court. 

When  Alice  was  three  years  old  she  was  taken  by  the  court 
from  her  parents,  both  of  whom  were  alcoholic  and  sexually 
delinquent,  and  placed  in  the  care  of  a  children's  agency.  She 
was  boarded  in  homes  of  the  best  sort,  and  given  up  by  one 
after  another  because  she  was  troublesome.  When  she  was 
about  thirteen  her  parents  kidnapped  her.  They  became  drunk 
and  quarreled,  and  the  father  after  having  the  mother  arrested 
took  the  child  to  a  shack  in  the  country  where  he  practiced 
incest.  She  was  rescued  by  the  police  and  committed  to  an 
industrial  school  as  "a  wayward  child,  grov/ing  up  in  circum- 
stances exposing  her  to  lead  an  immoral,  vicious,  and  criminal 
life."  At  the  school  she  made  a  fairly  good  record  and  was 
a  great  help  in  the  sewing  room  as  long  as  she  was  allowed 
to  be  prominent.  She  would  do  almost  anything  to  attract 
attention. 

In  childhood  she  had  fits  of  temper  when  she  would  scream 
for  an  hour  at  a  time.    She  showed  such  a  tendency  to  vulgarity 

167 


1 68  THE    KINGDOM    OF    EVILS 

that  she  could  not  be  allowed  to  play  with  the  neighbors'  chil- 
dren in  the  respectable  homes  where  she  was  boarded.  If 
crossed  she  became  sullen,  refused  to  eat,  threatened  to  kill  her- 
self, and  finally  got  into  a  state  of  nervous  excitement  that 
alarmed  her  friends.  A  physician  who  saw  her  thought  that 
she  should  be  kept  under  restraint  for  the  public  safety. 

When  she  was  allowed  to  leave  the  industrial  school  to  do 
housework  in  private  families  she  used  obscene  language  and 
was  lewd  in  her  manner  with  men  upon  the  street. 

Alice  was  sent  to  the  Psychopathic  Hospital  because  she 
threatened  suicide  when  a  girl  whom  she  had  known  at  the 
school  spread  stories  about  her  in  the  town  where  she  was 
working.  Five  months  later  she  was  returned  after  an  at- 
tempt to  take  poison.  On  this  occasion  she  had  been  allowec' 
to  visit  her  mother,  now  married  a  second  time  to  a  steady, 
respectable  man,  and  no  longer  alcoholic.  Her  mother  accused 
Alice  of  being  in  league  with  her  stepfather  to  run  the  house 
and  a  quarrel  arose  that  led  to  Alice's  attempt  to  kill  herself. 
The  medical  diagnosis  the  first  time  was  "not  psychotic."  The 
girl  was  distinctly  not  feeble-minded,  according  to  the  psycho- 
logical examiner.  She  appeared  bright  and  quick.  The  second 
time  she  was  in  the  hospital  the  final  conclusion  of  the  medical 
staff  was  that  there  was  a  question  of  early  dementia  praecox. 
The  Wassermann  reaction  was  positive  and  antisyphilitic  treat- 
ment was  given.  As  the  mother  had  syphilis,  the  presumption 
was  in  favor  of  the  opinion  that  Alice  was  a  case  of  congenital 
syphilis. 

The  family  chart  of  this  girl  is  very  black.  Her  mother  is 
a  high-grade  moron ;  both  parents  were  alcoholic  and  sex 
delinquents.  On  the  father's  side  the  grandfather  was  criminal- 
istic, the  grandmother  hysterical,  the  great-grandfather  a  sex 
delinquent.  On  her  mother's  side,  the  grandfather  and  great- 
grandfather were  alcoholic,  the  grandmother  was  feeble- 
minded, had  tuberculosis  and  was  alcoholic,  and  sex  delinquency 
appeared  among  the  great-aunts  and  uncles,  a  cousin  was 
insane.  Ten  of  the  family  were  confined  in  institutions  of  one 
sort  or  another. 

When  Alice  left  the  hospital  the  second  time,  she  had  become 
of  age  and  could  therefore  no  longer  remain  under  the  authority 
and  care  of  the  industrial  school,  so  she  was  taken  under  super- 
vision by  our  social  service.     In  the  position  found  for  her  she 


THE    KINGDOM    OF    EVILS  169 

did  satisfactory  work  but  was  unmanageable  because  of  her 
pert  and  independent  manner.  It  was  impossible  to  tell  what 
she  did  in  her  leisure  time;  but  she  could  not  live  at  home 
because  she  and  her  mother  could  not  keep  the  peace  when  long 
together.  Soon  without  warning  she  announced  her  marriage 
to  Joseph  Nardini,  who  had  been  given  to  drink  and  the  use  of 
morphine,  but  for  a  while  had  been  sober  and  industrious, 
working  as  a  grocer's  clerk.  The  results  of  our  supervision 
until  a  year  and  a  half  later,  when  the  family  moved  to  another 
state  where  Alice's  stepfather  had  found  promising  work  foi 
Joseph,  are  summarized  in  the  social  record  as  follows  : — 

May  28,  1914-March  II,  1 9 16 

Social: 

After  leaving  the  hospital  in  June,  1914,  a  position  at  the 
Roxbury  General  Hospital  was  secured  for  her  where  she 
remained  until  October,  1914.  She  left  without  serving  notice 
and  was  married  without  visitor's  knowledge  to  Joseph  Nar- 
dini, an  Italian  of  good  family.  Just  before  this,  she  was 
going  out  with  two  different  men,  both  of  whom  she  alleges 
made  improper  suggestions  to  her.    Boy  was  born  July  24,  191 5. 

With  the  exception  of  a  month  in  the  fall  of  191 5,  when 
the  patient  lived  with  her  mother  in  Westbridge  while  husband 
was  working  in  Eastboro,  they  have  lived  in  the  South  End. 
Patient's  husband  has  worked  in  a  grocery  store,  for  a  roofing 
company,  driving  an  automobile,  cleaning  streets,  and  as  porter 
in  a  bank,  earning  from  ten  to  sixteen  dollars  a  week.  The 
family  has  been  in  debt  most  of  the  time,  and  while  they  have 
made  regular  payments,  one  debt  would  no  sooner  be  paid 
than  another  would  be  contracted.  The  parents  of  both  patient 
and  husband  have  regularly  supplied  them  with  money  and 
with  clothes.  Of  a  bill  of  thirty  dollars  at  the  Maternity  Hos- 
pital, five  dollars  was  obtained  through  the  efforts  of  Miss 
Fuller,  a  visitor  to  the  Nardinis '  from  the  Charity  Organiza- 
tion Society.  When  the  family  went  to  New  York  state, 
March,  1916,  they  were  in  debt  over  one  hundred  dollars. 

Patient's  husband  has  had  periods  of  drinking,  and  for  over 
a  year  before  marriage  used  cocaine  and  morphine.  He  and 
patient  quarrel.  When  husband  is  intoxicated,  he  is  ugly  and 
will  strike  patient.  But  since  baby  was  born,  July,  191 5,  he 
has  treated  patient  better.     He  seems  devoted  to  the  baby. 

For  a  time  patient's  mother  and  patient's  husband  were  not 
on  friendly  terms,  and  patient  did  not  dare  let  her  husband 


170 


THE   KINGDOM    OF   EVILS 


know  when  she  had  seen  her  mother.  Husband's  parents  have 
tried  to  hold  up  to  both  patient  and  husband  a  high  standard 
of  conduct.  They  have  a  strong  sense  of  responsibiHty  for 
patient  since  she  has  married  into  the  family. 

Physical: 

Patient  was  given  antisyphilitic  treatment  here  the  first  sum- 
mer and  has  been  under  observation  of  Dr.  Scott  since.  When 
the  baby  was  born  in  the  Maternity  Hospital  patient  was  given 
ether.  The  delivery  was  normal.  Patient  had  trichaniasis  and 
was  in  the  Roxbury  General  Hospital  twice  in  fall  of  _  1915. 
She  is  not  living  according  to  the  diet  prescribed.  Patient  is 
looking  fairly  well,  but  has  lost  weight  since  leaving  the  hos- 
pital.   Is  kept  awake  at  night  with  the  baby. 

Mental: 

She  is  fond  of  her  husband  and  craves  affection  from  him, 
and  is  devoted  to  the  baby  although  she  does  not  wish  any  more 
children.  There  has  been  a  gradual  change  from  the  high- 
tempered,  self-willed  disposition  to  a  more  docile  and  obedient 
bending  to  husband's  wishes,  so  that  there  is  less  quarreling  at 
home.  In  February,  1916,  threatened  to  leave  husband,  but 
after  quarreling  one  half  day  and  sending  for  visitor,  went  back 
to  him.  In  December,  191 5.  had  a  noisy  quarrel  with  mother 
at  her  home.     Other  less  important  squabbles  occur. 

Patient  is  a  poor  housekeeper,  but  mother  says  she  is  im- 
proving. She  depends  upon  her  mother  to  do  a  good  deal  for 
her. 

When  they  returned  to  Boston  after  two  or  three  months  we 
reopened  the  case  and  results  during  a  period  of  nine  months 
follow : — 

June  I,  1915-February  29,  1917 
Social: 

Familv  returned  to  former  address  in  the  South  End  because 
they  found  it  impossible  to  live  on  husband's  wages.  Husband 
has  worked  more  regularly  since  his  return  and  makes  from 
twelve  to  sixteen  dollars  a  week.  He  has  straightened  out  and 
no  longer  drinks  or  abuses  patient.  Debts  are  paid  except 
fifteen  dollars  at  the  Maternity  Hospital.  Second  boy  born 
December  28,  1916. 

Physical: 

Patient  no  longer  requires  antisyphilitic  treatment.  Two 
weeks'  rest  in  the  country  was  urged  before  confinement,  but 
she  could  not  be  persuaded  to  go. 


THE    KINGDOM    OF    EVILS  I7I 

Mental: 

Patient  shows  marked  improvement  in  housekeeping  and 
personal  appearance.  She  takes  a  real  pride  in  her  home  and 
has  shown  marked  ability  in  sewing  for  the  children,  even 
making  some  dresses  for  her  husband's  young  sisters. 

She  is  less  impulsive  and  seldom  quarrels.  She  allows  her- 
self to  be  ruled  by  her  husband,  and  seems  happy  and  content 
with  her  life.  Her  voice  is  subdued  and  she  has  poise  and 
dignity  of  a  grown  woman. 

She  is  now  stated  as  not  psychotic.  She  is  considered  a 
psychopathic  individual  who  has  been  compensated  socially. 

Alice  was  much  improved  and  the  case  was  again  closed  as 
the  supervision  of  the  in-laws  seemed  adequate.  But  a  friendly 
call  three  months  later  brought  to  light  the  fact  that  Joseph 
had  been  sentenced  to  the  house  of  correction  for  a  year  and  a 
half  for  drawing  a  revolver  upon  an  officer  who  interfered  in 
the  advances  of  himself  and  his  companions  to  some  girls  upon 
the  street.  Apparently  Joseph  had  no  malicious  intentions,  but 
the  law  had  its  way  with  him.  Alice  was  being  supported  by 
public  aid  and  her  father-in-law.  We  joined  Mr.  Nardini  in 
an  effort  to  bring  about  the  release  of  Joseph,  who  after  serv- 
ing six  months  of  his  sentence  was  paroled.  By  this  time  the 
original  problem  of  the  training  of  a  somewhat  psychopathic 
girl  had  been  eclipsed  by  the  "family  problem"  of  the  Nardinis, 
and  we  asked  a  family  agency  to  take  the  case.  When  we 
heard  of  the  Nardinis  recently,  Joseph  had  been  drafted  into 
the  army.  Before  he  went  he  had  been  drinking  and  taking 
morphine  and  had  been  abusive  to  his  wife.  He  had  gone  about 
openly  with  a  woman  whom  Alice  styles  "a  regular  bum."  She 
is  now  endeavoring  to  discover  an  opportunity  for  the  police 
to  arrest  the  woman ;  and  is  thinking  of  going  to  court  for  sep- 
arate maintenance  when  Joseph  comes  home. 

The  improvement  in  Alice  herself  (aside  from  the  condition 
of  the  family)  during  the  four  years  we  have  known  her  is  a 
matter  of  some  surprise.  Considering  her  bad  heredity,  and 
unfortunate  early  experiences,  and  her  unstable  character,  we 
did  not  expect  as  much  stability  as  she  has  developed.  In  spite 
of  many  handicaps  she  has  shown  continued  progress.  Joseph, 
while  he  has  had  his  good  spells,  has  been  a  difficult  husband  to 
manage  even  with  the  help  of  able  in-laws.  Alice's  mother, 
though  kind  and  helpful  for  the  most  part,  has  an  uncertain 


1^2  THE    KINGDOM    OF    EVILS 

temper  and  once  at  least  was  intoxicated  and  "disgraced"  her 
daughter  in  the  eyes  of  the  Nardini  family.  Alice  herself  has 
had  a  good  deal  of  sickness  and  the  first  baby  had  ear  abscesses 
and  the  second  child  was  in  a  hospital  at  eleven  months  for 
feeding  troubles.  The  third  child  was  never  well  and  died 
at  three  months.  The  uncertainty  of  their  income  has  been 
another  burden  upon  Alice,  for  although  funds  have  always 
been  forthcoming,  Joseph's  irregular  habits  of  work  and  ten- 
dency to  gamble  as  well  as  drink  have  kept  the  family  most  ol 
the  time  in  debt. 

During  the  first  pregnancy  Alice  was  given  antisyphilitic 
treatment  regularly,  and  the  baby  was  a  fine  child.  Before  the 
birth  of  the  second  child  she  was  under  medical  observation, 
but  treatment  was  not  considered  necessary.  This  baby  also  is 
well  and  sturdy.  When  we  referred  Alice  to  a  general  hospital 
for  treatment  for  syphilis,  the  diagnosis  upon  our  medical 
record  "question  of  early  dementia  praecox"  proved  to  be  a 
snag,  for  the  superintendent  of  the  hospital  to  which  we  wished 
to  refer  her  replied  that  in  view  of  the  diagnosis  "the  patient 
was  directed  to  return"  to  our  hospital,  since  if  there  was  "any 
question  of  mental  disease  in  her  case"  he  felt  she  belonged 
in  the  care  of  our  hospital.  The  matter  was  finally  adjusted, 
with  some  difficulty,  upon  a  statement  from  one  of  our  physi- 
cians that  Alice  Nardini  was  "not  a  mental  case." 

Hours  spent  by  IMedical  record,  17  pages 

Social  record,  31   pages 
Physician,  5%.  Social  work  : 

Visits,  48 
Psychologist,   i  Interviews  at  hospital,  1 1 

Telephone  calls,  6 
Social  worker,  76^4  Letters,  16 


Incompetent  young  wife  quarrels  with  in-lazvs,  then  quarrels 
zvith  husband,  who  deserts. 

Case  32.  Although  Catherine  O'Connor  by  psychological 
tests  would  be  classed  among  high-grade  morons  (she  graded 
at  II. 6  years  by  the  Point  Scale  and  was  twenty-three  years 
old  when  tested),  she  was  bright  and  teachable,  fairly  intelli- 


THE    KINGDOM    OF    EVILS  173 

gent,  and  even  capable  when  she  exerted  herself.  She  was  not 
mentally  different  from  many  women  coming  to  social  agencjes 
whose  intelligence  is  never  questioned  to  the  extent  of  psycho- 
logical tests.  While  her  case  might  be  regarded  as  presenting 
difficulties  in  the  group  of  morbi,  owing  to  her  somewhat  defec- 
tive intelligence,  yet  the  factor  of  intelligence  defect  played  a 
relatively  small  part  in  her  treatment,  and  the  main  difficulties 
to  be  dealt  with  lay  in  the  moral  and  financial  fields.  After 
the  desertion  of  her  husband  the  question  of  support  for  herself 
and  the  children  was  the  pressing  consideration.  Her  moral 
difficulties  were  faults  of  "temper."  Up  to  the  time  of  her 
marriage  she  showed  an  easy-going  disposition  and  had  no 
particular  trouble.  As  a  child,  however,  she  was  somewhat 
peculiar,  having  sullen  spells  when  she  would  go  two  and  three 
weeks  at  a  time  without  speaking  to  anyone  in  the  house. 
After  the  birth  of  her  first  child,  she  quarreled  continually  with 
her  husband  and  lost  no  opportunity  to  be  rude  to  his  family, 
whom  she  disliked.  She  would  burn  presents  that  they  sent 
to  the  baby.  At  times  she  had  thrown  dishes  at  her  husband 
and  refused  to  cook  his  meals.  She  never  did  justice  to  her 
housekeeping,  and  was  slack  and  untidy.  The  husband  also 
was  of  an  easy-going  disposition  and  quick  temper  and  bore 
up  his  end  of  the  family  quarrels.  After  one  particularly  violent 
scene,  in  which  Catherine  became  very  much  excited  and 
obsessed  with  the  idea  that  her  sister-in-law  intended  to  take 
her  baby  away,  a  doctor  was  called,  who  advised  sending  her  to 
the  Psychopathic  Hospital  for  observation.  She  said  he  told 
her  "the  hospital  would  be  a  good  place  to  rest  in"  and  she  was 
willing  to  come. 

The  story  of  social  treatment  during  two  years  and  nine 
months  is  briefly  told  in  a  summary  from  our  record  prepared 
for  the  Associated  Charities  in  another  city  to  whom  the  case 
was  referred  after  Mr.  O'Connor  had  returned  and  the  family 
had  been  transplanted  to  a  new  neighborhood.  We  asked  that 
a  friendly  visitor  keep  in  touch  with  them.  Both  Mr.  and  Mrs. 
O'Connor  had  shown  marked  improvement  apart,  but  it  re- 
mained to  see  whether  they  could  attain  stability  in  their  corn- 
mon  life.     A  copy  of  the  summary  follows  : — ■■ 


174  THE    KINGDOM    OF    EVILS 


SUMMARY 

Social  History: 

Patient  is  an  American  born  woman,  twenty-six  years  old. 
of  Irish  parentage.  She  is  a  pretty  woman,  short  and  sHght, 
has  pleasing  manners  and  an  attractive  smile.  Patient  was 
married  six  years  ago  to  Frank  O'Connor.  For  a  time  they 
were  happy  together,  but  after  the  birth  of  the  first  child,  191 3. 
there  was  constant  friction.  The  husband  earned  fourteen 
dollars  per  week,  and  patient  had  great  difficulty  in  making 
both  ends  meet.  Patient  also  did  not  get  along  well  with  her 
husband's  family.  She  felt  that  they  were  trying  to  take  her 
child  from  her.  Finally  the  husband  had  patient  sent  to  this 
hospital,  June,  191 5.  They  were  advised  to  separate,  but 
decided  not  to  and  apparently  were  happier.  Five  months  a  f tcr 
birth  of  second  child,  January,  191 6,  patient's  husband  deserted 
her.  Patient  was  sent  to  Peterboro  for  a  vacation.  She  en- 
joyed the  place  so  much  that  she  decided  to  remain. 

For  fourteen  months  she  and  her  l^aby  Marion,  now  a  year 
and  a  half  old.  lived  in  Peterboro.  where  the  patient  worked  as 
stitcher  in  one  of  the  Fox  &  Blake  shoe  factories.  Patient 
earned  between  seven  and  ten  dollars  per  week  with  which, 
together  with  the  small  amount  given  her  by  her  sister  Mary, 
she  supported  Marion  and  herself.  Patient  was  well  liked  by 
her  employers  and  made  many  friends  in  Peterboro.  While 
there  she  lived  in  three  different  places  in  each  of  which  there 
was  someone  to  care  for  Marion  during  the  time  patient  was 
working.  Patient's  older  child,  Winifred,  four  years  old,  is 
well  cared  for  Ijy  Mrs.  Edward  O'Connor,  36  Troy  Street, 
Foxbridge,  mother-in-law  of  patient. 

Early  in  the  spring  of  191 7,  patient  heard  that  her  husband 
had  deserted  from  the  army  in  which  he  had  enlisted  under  an 
assumed  name.  In  June  he  returned  to  Boston  and  went  to 
see  patient  several  times.  He  gave  himself  up  and  served  a 
sentence  of  eight  months  at  Blackport  Island. 

In  October,  191 7,  patient  was  not  able  to  work  more  than 
three  or  four  days  a  week  because  of  fatigue,  due  to  preg- 
nancy. November  13,  she  and  Marion  went  to  board  at  12 
Ford  Street,  where  they  had  an  attractive  bedroom,  a  sitting 
room,  opening  on  an  enclosed  porch,  together  with  board  for 
nine  dollars  a  week. 

Patient's  board  was  paid  by  the  Red  Cross  until  February 
9,  19 1 8,  at  which  time  the  sentence  of  patient's  husband  ex- 
pired, and  he  returned  to  Boston.    Previously  patient's  husband 


THE    KINGDOM    OF    EVILS  I75 

had  been  an  unstable,  irresponsible  young  man,  lacking  in  am- 
bition. Since  his  return,  however,  his  entire  attitude  has 
changed.  He  at  once  sought  work  and  secured  a  position  as 
meat-cutter  at  fifteen  dollars  per  week.  The  second  week  he 
was  raised  to  sixteen  dollars.  He  was  desirous  of  leaving  this 
city  and  making  a  new  start.  He  chose  Lawrence,  went  to  the 
Y.  M.  C.  A.  there,  secured  employment  at  seventeen  dollars 
per  week  in  a  factory  and  in  addition  worked  as  meat-cutter 
for  Saturday  afternoon  and  evenings.  Eighteen  dollars  was 
lent  him  to  pay  patient's  board  for  two  weeks ;  of  this  he  has 
already  paid  back  sixteen  dollars.  Three  dollars  additional 
was  given  to  patient,  so  husband  now  owes  this  hospital  five 
dollars. 

On  February  28  patient  was  confined  at  the  Maternity  Hos- 
pital, where  she  gave  birth  to  a  boy  weighing  six  pounds,  four 
ounces,  and  where  she  remained  eleven  days.  She  then  returned 
to  12  Ford  Street  for  two  weeks,  her  board  being  paid  by 
Country  Week.  Patient  and  baby  then  spent  a  few  days  with 
patient's  sister  Mary,  in  Arlington.  March  30  patient  joined 
her  husband  in  Lawrence. 

During  patient's  confinement,  baby  Marion  came  down  with 
scarlet  fever  and  is  now  in  the  Contagious  Hospital  doing 
fairly  well. 

Physical  History: 

Patient  had  a  normal  birth  and  development.  Her  children's 
births  were  normal.  While  her  husband  was  in,  she  became 
pregnant  and  was  confined  in  February.  During  early  part  of 
last  pregnancy  patient  was  examined  at  Suffolk  General  Hos- 
pital and  while  at  12  Ford  Street  attended  a  prenatal  clinic. 
There  was  nothing  unusual  during  her  confinement. 

Mental  History: 

Patient  went  to  the  seventh  grade  in  school.  She  is  fond 
of  reading  and  dancing,  but  had  had  little  recreation  since 
marriage.  She  is  untidy  and  slack  as  a  housekeeper,  but  when 
she  tries  she  keeps  herself  and  her  baby  neat  and  clean. 

Patient's  psychological  examination  at  this  hospital  showed 
that  she  graded  at  11. 6  years.  Diagnosis  was:  Not  insane. 
Since  leaving  hospital  in  191 5,  patient  has  been  under  the  care 
of  the  social  service.  She  has  done  her  best  to  carry  out  sug- 
gestions made  to  her,  especially  recently,  and  is  always  appre- 
ciative of  what  is  done  for  her. 

Patient  is  optimistic  about  the  future  and  greatly  pleased 


1/6  THE    KINGDOM    OF    EVILS 

because  of  the  change  in  her  husband's  attitude.  She  is  eager 
to  have  a  happy  home  and  reaHzes  that  she  must  do  her  share 
to  make  it  so.  She  also  has  become  more  interested  in  hygiene 
and  in  the  health  of  her  children.  At  present  she  is  greatly 
worried  about  Marion,  to  whom  she  is  devoted.  She  is  amen- 
able to  social  treatment. 

A  year  after  the  family  left  Boston,  one  of  the  social  workers 
who  had  dealt  with  them  (three  social  workers  had  in  turn 
charge  of  the  case)  happened  to  be  near  their  new  home  and 
called.  She  found  Mr.  O'Connor  doing  well,  and  Mrs.  O'Con- 
nor happy  in  a  good,  well-kept  home.  The  whole  family  had 
been  sick  with  the  influenza  during  the  epidemic  and  Mr.  O'Con- 
nor had  nursed  them.  The  oldest  child,  a  beautiful  little  girl, 
died.  Even  under  the  strain  of  this  grief,  Mrs.  O'Connor  has 
remained  reliable.  Mr.  O'Connor  is  still  going  "up  the  ladder" 
as  he  expresses  it,  in  a  letter  we  quote  below : 

"My  Dear  IMiss  Goode: 

"Received  your  letter  last  week  sometime,  but  as  I  am  not 
much  of  a  hand  at  writing  it  took  me  until  today  to  answer 
it.  I  hope  that  you  have  thoroughly  recovered  from  your  ill- 
ness. I  suppose  that  you  will  be  mad  at  me  for  writing  to 
Catherine  and  having  her  come  up  here.  I  found  two  nice 
rooms  near  my  work  and  I  also  thought  that  it  would  be  better 
for  Catherine  to  be  here  because  she  was  worrying  over  Marion. 
Being  up  here  might  take  her  mind  off  thinking  of  her.  Now 
of  course  I  know  she  will  be  all  right  at  the  hospital  under 
the  conditions.  As  I  understand  from  Catherine  I  have  got  to 
pay  for  her  board  and  treatment  there,  also  the  other  expense 
of  two  visits  of  the  doctors.  I  am  doing  all  I  can  to  make 
good.  I  have  secured  a  position  in  a  market  for  Saturday 
afternoons  and  evenings.  So  you  can  see  that  I  am  trying  my 
best  to  get  up  the  ladder  as  soon  as  I  can  and  I  hope  to  con- 
tinue. I  am  in  hopes  that  nothing  more  will  come  up  to 
greaten  the  expense  any  more.  I  am  very  thankful  for  all  of 
the  good  things  you  have  done  for  both  Catherine  and  myself. 
I  will  never  forget  them  you  have  been  my  friend.  Now  as 
soon  as  I  can  I  will  try  and  straighten  out  all  matters  with  you. 
I  would  like  very  much  to  see  you  but  it  is  almost  asking  too 
much  to  call  up  to  see  me.  I  want  to  keep  in  touch  with  both 
you  and  the  Y.  M.  C.  A. 

"Sincerely, 

"Frank  O'Connor." 


THE    KINGDOM    OF    EVILS  I77 

Hours  spent  by  Medical  record,  39  pages 

Social  record,  53  pages 
Physician,  5  Social  work  : 

Visits,  49 
Psychologist,  i  Interviews  at  hospital,  18 

Telephone  calls,  75 
Social  worker,  100  Letters,  45 


Persistent  forger  and  "ne'er-do-well/' 

Case  33.  Ignatz  Simanski  forged  a  number  of  worthless 
checks  totaling  $176  all  within  a  period  of  eight  days.  Siman- 
ski was  an  American-born  Polish  Jew  who  had  gone  back  o 
Berlin  in  his  teens,  worked  with  various  firms,  and  was  an  in- 
terpreter seven  years.  Apparently  he  lived  very  well  in  Europe, 
but  never  sent  money  to  his  mother  or  sister.  He  kept  mis- 
tresses in  Europe.  He  did  not  want  to  enlist  in  the  war,  was 
ashamed  not  to,  and  finally  left  Europe  to  keep  out  of  the  war. 
An  artist  divorcee  with  whom  he  became  infatuated  used  up 
his  money.  The  forging  then  began.  He  got  out  of  prison 
in  eleven  months,  without  money  or  clothes.  A  friend  of 
Simanski's  sister  advised  him  to  go  to  the  Psychopathic  Hos- 
pital suspecting  that,  with  his  record,  he  might  be  a  victim  of 
psychopathic  personality.  He  came  and  was  put  under  a  sort 
of  supervision.  Assistance  was  given  him — a  week's  board 
and  shoes.  A  job  was  got  for  him  in  a  munition  factory. 
Three  months  after  there  had  to  be  a  tonsil  operation  which 
was  arranged  for.  Upon  emerging  from  the  hospital  he  was 
again  destitute.  That  Simanski  was  in  any  psychopathic  (ex- 
cept under  that  extreme  view  of  delinquents  which  regards 
them  as  all  in  some  sense  psychopathic)  was  very  doubtful.  He 
was  referred  to  an  agency  for  homeless  men  and  the  case  was, 
from  the  Psychopathic  Hospital  point  of  view,  closed.  It  ap- 
peared from  recent  advices  that  Simanski  was  married  and  is 
making  good  in  a  small  way.  Of  course,  he  is  not  cutting  the 
rather  wide  figure  which  apparently  he  cut  in  Europe  and 
shortly  after  his  return.  Whether,  in  the  long  run,  he  will  turn 
out  again  a  more  markedly  delinquent,  or  whether  he  will  be- 
come obviously  psychopathic  is  a  question.  Of  a  psychopathic 
trend  we  found  no  sign. 


178  THE    KINGDOM    OF    EVILS 

We  have  described  Ignatz  Simanski  as  a  case  without  pre- 
dominant or  certain  medical  disorder.  Perhaps  we  should  re- 
gard him  as  a  moral  problem  and  lay  stress  upon  his  irrespon- 
sibility and  selfishness,  which  we  ascribe  to  educational  defi- 
ciency. Superficially  viewed,  this  man  has  developed  sundry 
vices,  but  whether  he  is  accessible  to  moral  treatment  in  the 
ordinary  sense  of  that  treatment  is  to  be  doubted.  Just  as  some 
authorities  view  crime  as  a  sort  of  disease,  so  others  view  crime 
as  a  sort  of  vice.  We  do  not  wish  to  enter  the  lists  to  argue 
these  views.  In  any  event,  the  problem  of  Simanski  is  one 
of  low  moral  standards  combined  with  economics. 

Hours  spent  by  Medical  record,  4  pages 

Social  record,  8  pages 
Physician,  3%  Social  work  : 

Visits,   3 
Psychologist,  o  Interviews  at  hospital,  7 

Telephone  calls,  21 
Social  worker,  isJ/2  Letters,  20 


Psychoneurotic  plumber  unable  to  zvork  for  six  years. 
Afraid  to  go  out  alone. 

Case  34.  Daniel  Griffin  is  a  case  we  choose  to  analyze  as 
one  of  almost  purely  medical  difficulty.  Educationally  he  was 
rather  unusually  without  blemish,  achieving  the  highest  mental 
age  level  consistent  with  the  scales  in  use  and  achieving  a  gen- 
eral intelligence  score  of  97.  The  psychologist  noted  that 
Griffin's  performance  was  exceedingly  good  in  the  construction 
puzzles  for  example,  but  that  he  took  much  longer  time  on  a 
second  trial  than  on  the  first,  since  he  became  very  nervous 
and  feared  that  the  second  trial  would  fall  off  in  excellence,  al- 
though he  cooperated  well  and  showed  great  interest  in  both 
tests.  He  afterward  complained  of  being  greatly  fatigued  as 
he  had  not  slept  at  all  the  night  before. 

Thus,  although  psychological  tests  are  not  as  a  rule  extremely 
good  sources  of  psychiatric  data  (as  we  cannot  carry  over  a 
specific  deficiency  in  given  tests,  such  as  one  for  oversuggesti- 
bility  for  instance,  to  argue  a  general  psychiatric  oversuggesti- 
bility),  yet  Griffin's  behavior  during  the  tests  suggested  the 
disease  of  which  we  think  him  the  victim.     Beyond  question 


THE    KINGDOM    OF    EVILS  1 79 

he  belongs  to  the  psychoneurotic  group-.  He  came  voluntarily 
to  the  Psychopathic  Hospital,  complaining  of  feeling  tired.  He 
had  had,  he  averred,  a  nervous  dread  for  some  five  years.  It 
was  not  a  particular  dread,  but  there  was  a  feeling  that  some- 
thing terrible  was  going  to  happen.  He  was  worried  because 
he  could  not  get  on  his  feet  and  could  not  make  a  man  of  him- 
self.    He  himself  called  his  disease  "neurasthenia." 

He  had  been  a  plumber  and  said  that  he  had  contracted  lead 
poisoning,  which  was  the  cause  of  his  disorder.  However,  at 
another  time  he  explained  the  beginning  of  his  disorder  in 
a  bout  of  rivalry  over  some  bit  of  technique  in  the  plumber's 
trade  with  a  man  who  beat  him  in  performance.  All  this  he 
had  taken  much  to  heart.  Whenever  that  particular  thing  was 
to  be  done  in  plumbing  he  kept  having  precisely  the  same  creepy 
feeling  that  ran  over  him  the  day  his  fellow  workman  over- 
reached him. 

For  some  six  years  Griffin  had  not  worked.  Mornings  he 
felt  shaky  and  trembly,  was  without  ambition,  and  could  not 
seem  to  "get  started."  He  felt  a  dread  that  "something  might 
happen"  to  him  if  he  were  alone.  Evenings  he  would  feel 
better  and  might  then  take  a  solitary  walk.  Day  times,  how- 
ever, he  could  never  prevail  upon  himself  to  go  out.  Day 
times  he  read  or  helped  his  mother  about  the  house.  He  was 
interested  in  lectures,  in  studying,  and  in  serious  conversation. 
He  spurned  moving  pictures.  Whereas  he  had  for  a  long  time 
been  very  fond  of  athletics,  he  now  had  no  stomach  for  any- 
thing except  treatment  for  his  nervous  trouble.  His  brothers 
and  sister,  he  said,  had  ostracized  him.  He  was  angry  with 
one  brother,  though  in  point  of  fact  at  least  a  part  of  his 
feeling  might  be  attributed  to  his  vexation  at  not  having  his 
doctor's  bills  paid  by  the  family.  There  appeared  to  be  no 
religious  or  sex  concern  in  Griffin. 

Griffin  presented  a  good  general  appearance,  though  his 
manner  was  a  bit  effeminate.  He  was  not  sad  but  anxious  in 
expression  and,  though  for  the  most  part  agreeable,  became 
at  other  times  petulant.  He  had  been  referred  from  the  out- 
patient department  into  the  wards  of  the  Psychopathic  Hos- 
pital. As  soon  as  he  entered  the  wards  he  wanted  to  know  how 
soon  he  could  go  home.  Nevertheless,  he  stayed,  being  funda- 
mentally willing  enough.  His  fault-finding  would  run  after 
this  fashion :    "This  has  been  a  strenuous  evening  for  me,"  he 


l80  THE    KINGDOM    OF    EVILS 

would  say.  "I  just  got. through  with  the  lady  with  the  puzzles 
and  it  has  affected  me." 

Nothing  psychiatrically  other  than  the  above  was  found 
in  Griffin's  rather  short  stay  (six  days)  in  the  wards,  whence 
he  was  discharged  (as  the  clinic  slang  has  it)  "to  self  and  to 
the  out-patient  department." 

He  has  been  under  observation  for  a  good  part  of  a  year 
and  is  perhaps  a  bit  better.  He  is  now  being  got  to  take  more 
interest  in  housework  and  repairs  about  the  house,  upon  which 
he  spends  several  hours  a  day.  He  thinks,  or  at  least  states, 
that  his  visits  to  the  department  are  of  little  avail.  He  insists 
that  physicians  should  tell  him  concretely  what  will  make  him 
well.  He  would  rather  like  to  have  his  excellent  psychological 
rating  on  paper  to  present  to  friends  as  evidence  that  he  is  men- 
tally normal.  In  all  the  visits  that  he  has  made  to  the  out- 
patient department,  he  had  never  yet  been  able  to  go  alone 
although  he  has  from  time  to  time  made  elaborate  plans  to  get 
to  the  hospital  alone.  Evidently  the  brief  trip  seems  to  him  a 
compHcated  tour.  He  protests  that  he  must  not  come  in  the 
car  with  a  social  worker  because  he  will  "look  awkward."  The 
family's  attitude  to  Griffin  is  altered  again  to  one  of  affection. 

This  case  we  have  picked  as  one  of  relatively  uncomplicated 
medical  interest.  As  above  noted,  he  is  psychologically  on  a 
rather  superior  level.  Morally  one  might  lay  up  to  him  as  a 
kind  of  vice  or  bad  habit  the  attitude  towards  work  which  he 
has  assumed.  It  is  somewhat  a  question  of  terminology, 
whether  we  shall  regard  this  psychoneurotic  attitude  as  dis- 
tinctly a  kind  of  vice  or  bad  mental  habit.  To  be  sure,  the 
effects  of  the  psychoneurosis  are  found  in  the  moral  sphere 
and  affect  both  emotions  and  the  will.  But  probably  that  ana- 
lyst would  go  quite  wrong  who  should  feel  that,  by  those  moral 
measures  that  aid  the  normal  person  who  falls  into  moral 
difficulties,  he  could  restore  Daniel  Griffin.  Naturally  the 
proof  of  the  pudding  in  this  case,  as  in  many  others,  lies  in  the 
eating. 

Nor  would  we  deny  that  some  cases  called  psychoneurosis 
have  been  cured  by  the  usual  moral  measures  at  the  conmiand  of 
the  adult  person  of  common  sense  who  knows  something  about 
the  world  and  has  a  modicum  of  personality.  Of  course,  too, 
in  some  wide  sense  of  the  term,  these  common-sense  moral 
measures  might  be  regarded  as  a  form  of  psychotherapy.     On 


THE    RiNGDOM    OF   EVILS  ,l8l 

this  extremely  wide  (and  we  think  excessively  wide)  interpre- 
tation, even  the  processes  of  normal  education  as  well  as  those 
of  moral  training  would  fall  under  the  caption  psychotherapy. 
But  psychotherapy,  strictly  speaking,  is  a  form  of  therapy,  and 
the  term  therapy  has  come  to  be  used  as  signifying  treatment 
of  disease  or  defect.  No  doubt,  then,  in  a  case  like  that  of 
Daniel  Griffin,  ordinary  measures  must  be  used  just  as  ordi- 
nary devices  of  education  and  instruction  must  be  used.  But 
the  stock  moral  measures  of  the  community  will  not  serve 
and  (as  Daniel  Griffin's  five  or  six  years  of  proper  contacts 
with  an  excellent  family  prove)  have  not  served  to  turn  the 
trick. 

To  be  sure,  our  own  efforts  have  not  been  crowned  with 
complete  success — nor  may  they  ever  be,  despite  the  uninter- 
rupted up-curve  which  we  have  in  the  past  months  noted. 
What  the  real  cause  of  psychoneurosis  actually  is  remains  to 
medical  minds  a  question.  We  do  not  need  here  to  mention  the 
various  psychogenic  explanations  which  have  been  offered. 
Griffin  was  in  charge  of  a  competent  physician  fully  cognizant 
of  various  modern  suggestions  as  to  the  mental  origin  of  sun- 
dry kinds  of  psychoneurosis.  Whether  psychogenic  causes 
were  absent  or  whether  they  simply  were  not  discovered,  at  all 
events,  no  single  or  removable  cause  has  ever  been  alleged  for 
Griffin.  AH  legal  and  virtually  all  economic  difficulties  fail  to 
complicate  the  case.  There  was  indeed  nothing  in  Griffin's 
life  or  history,  as  so  far  brought  out,  which  could  combine  with 
his  psychoneurosis  to  form  a  picture  like  many  of  those  before 
described. 

Griffin  is  the  first  of  five  cases,  in  which  we  are  attempting 
to  display  comparatively  uncomplicated  instances  of  medical 
(Daniel  Griffin),  educational  (John  Henry),  moral  (Clara 
Perkins),  legal  (Nathan  Blumberg),  and  economic  (Margaret 
Dolan)  disability.  Thus  the  cases  of  slightly  greater  com- 
plexity with  which  Griffin's  case  could  readily  be  compared, 
are  cases  24  to  27.  Of  these  four  cases  of  medical  trouble 
combined  with  one  or  other  type  of  non-medical  trouble,  two 
(case  24,  David  Stone,  and  case  27,  Herman  Simonson)  are 
also  cases  of  psychoneurosis.  The  case  of  David  Stone  we 
regarded  as  a  binary  combination  of  medical  and  educational 
deficiency,  whereas  Herman  Simonson  we  regarded  as  a  com- 
bination of  medical  and  economic  trouble. 


182  THE    KINGDOM    OF    EViLS 

In  passing  it  may  be  noted  that  case  25,  Alfred  Stevens,  was 
also  at  first  thought  to  be  a  case  of  psychoneurosis.  That  case 
of  Alfred  Stevens  was  in  fact,  the  striking  case  in  which  altera- 
tion of  the  physician's  estimate  from  psychoneurosis  to  cyclo- 
thymic constitution  (constitutional  slight  melancholia)  made  so 
profound  a  difference  to  the  man's  happiness  and  self-support- 
ing power. 

Hours  spent  by  Medical  record,  19  pages 

Social  record,  23  pages 
Physician,  4^  Social  work: 

Visits,  22 
Psychologist,  i  Interviews  at  hospital,  4 

Telephone  calls,  20 
Social  worker,  453/^  Letters,  45 


Boy  kept  a  prisoner  by  insane  mother.  Enforced  seclusion 
did  not  prevent  'intellectual  development. 

Case  35.  John  Henry  was  a  nine  days'  wonder  in  the 
newspapers.  He  was  a  fifteen-year-old  boy  who  was  "rescued" 
from  a  dark  cellar  where  his  mother  had  kept  him  five  months. 
The  older  medical  textbooks  used  to  tell  of  certain  "wolf 
boys,"  of  whom  the  celebrated  Caspar  Hanser  was  one  of  the 
first  to  bring  up  the  problem  whether  an  absolute  lack  of  normal 
education  would  so  dull  or  retard  development  as  to  produce 
in  itself  insanity  or  feeble-mindedness.  The  wolf-boy  question 
hardly  admits  a  general  answer.  No  doubt  many  of  the  wild 
waifs  picked  up  in  the  woods  are  actually  feeble-minded  or 
victims  of  dementia  praecox.  John  Henry  was  not  in  that 
sense  a  wolf  boy.  He  had  been  kept  in  his  cellar  on  1  strange 
hypothesis.  His  mother  had  kept  him  back  in  school ;  she 
persuaded  the  teachers  to  hold  John  back  on  the  score  of  his 
feeble-mindedness. 

Naturally,  after  John's  somewhat  picturesque  rescue,  he  be- 
came the  especial  object  of  the  psychologist's  attention.  Mira- 
bile  dictu,  John  graded  virtually  at  normal.  At  a  chronological 
age  of  fifteen  and  a  half  years,  his  Point  Scale  level  stood  at 
16,  and  his  level  on  the  Stanford  scale  stood  at  15.5. 

This  case  so  well  illustrates  the  peculiar  and  critical  advan- 
tages of  mental  tests  in  certain  instances,  that  we  here  trans- 


THE    KINGDOM    OF    EVILS  183 

cribe  a  large  portion  of  a  special  report  made  by  the  psycholo- 
gist at  the  Psychopathic  Hospital,  Dr.  Josephine  Foster.^  This 
report  includes  some  notes  upon  John's  present  situation  and 
progress. 

REPORT   OF   A   CASE  IN    WHICH    ENFORCED   SECLUSION    DID   NOT 
PREVENT   INTELLECTUAL  DEVELOPMENT 

The  psychologist  who  gives  "mental  tests"  is  frequently  met 
by  the  statement :  "This  low  mental  age  means  nothing  because 
the  child  has  been  sick  and  has  not  been  a  regular  attendant 
at  school"  or  by :  "You  can't  expect  a  child  who  has  lived  on 
a  lonely  farm  and  who  has  had  no  playmates  to  test  at  age." 
In  vain  may  the  psychologist  answer :  "I  admit  that  inability 
to  read  may  lower  the  mental  age  with  a  scale  like  the  Binet 
or  the  Point  Scale.  In  other  respects,  however,  school  training 
has  little  influence  on  the  outcome  of  psychological  examina- 
tions." Such  a  reply  usually  fails  to  carry  conviction  to  one 
who  is  not  an  experienced  examiner.  Instead,  an  objector  is 
likely  to  depart,  thinking  that  the  psychologist  is  grossly  ex- 
aggerating the  importance  of  the  tests,  resolving  to  take  mental 
ages  in  the  future  with  as  large  a  grain  of  salt  as  ever,  and 
continuing  to  consider  the  mental  age  only  when  it  agrees  with 
his  personal  opinion  of  the  case. 

In  our  work  at  this  hospital  we  have  come  to  use  the  answer : 
"Let  me  tell  you  about  a  fifteen-year  old  boy  we  examined  some 
months  ago."  The  illustration  has  been  so  successful  that  we 
offer  it  here  to  other  psychologists  for  similar  use. 

John  Henry  (this,  of  course,  is  not  the  real  name,  but  it  is 
like  it  in  having  the  same  second  name,  which  the  boy  spelled 
Henery)  was  born  in  a  rather  poor  district  of  a  New  England 
city  on  August  13,  1902.  Of  his  remote  ancestors  we  know 
comparatively  little.  Presumably  his  paternal  grandparents 
were  natives  of  Ireland.  His  maternal  grandparents  are  said 
by  one  of  our  informants  to  have  come  from  England  and 
Scotland,  and  by  another  to  have  been  born  in  Nova  Scotia 
and  Maine.  We  have  one  history  which  says  that  a  maternal 
uncle  died  in  an  insane  asylum.  Another  maternal  uncle,  who 
came  to  the  hospital  upon  request,  is  reported  to  have  been 
insane,  and  appeared  to  be  very  unintelligent  and  was  consid- 

1  Foster,  Josephine  Curtis.  A  Case  in  Which  Enforced  Seclusion  Did  Not  Pre- 
vent Intellectual   Development.     In  Journal   of  Applied  Psychology,  June,    19 19. 


184  THE    KINGDOM    OF    EVILS 

ered  as  "probably  untrustworthy  in  his  statements."  This  uncle 
denied  mental  illnesses  in  the  family,  but  at  the  same  time 
showed  such  familiarity  with  hospitals  for  the  insane  as  to 
suggest  personal  acquaintance.  Of  the  boy's  immediate  family, 
the  father  was  born  in  Ireland,  and  was  probably  a  horse- 
trainer.  He  was  heavily  alcoholic,  abused  the  children,  and 
some  five  years  ago  deserted  the  family.  John's  mother  was 
born  in  New  England.  She  was  at  this  hospital  for  a  time, 
and  is  now  an  inmate  of  a  state  hospital  for  the  insane  with  a 
diagnosis  of  dementia  praecox,  paranoid.  Four  of  John's 
siblings  are  said  to  have  died  of  starvation  in  the  first  year. 
An  older  half-sister  is  apparently  normal. 

The  schooling  of  John  and  this  half-sister  Julia  was  decidedly 
meager.  They  were  allowed  to  attend  school  occasionally,  but 
although  both  of  them  learned  to  read,  they  acquired  little  else. 
If  we  could  add  together  all  the  days  John  spent  in  school,  they 
might  come  to  three  years.  We  know  that  the  family  moved  so 
frequently  (at  least  eleven  times  in  five  years)  that  he  could 
seldom  have  spent  a  full  term  in  any  one  school.  John  was 
last  in  the  fourth  grade.  He  attended  school  in  this  grade 
irregularly  for  some  years.  Apparently  he  was  not  held  from 
advancement  on  account  of  dullness,  but  because  the  mother 
went  to  the  teacher  and  said :  "Don't  waste  any  time  over  this 
boy  of  mine.  He  is  feeble-minded  and  will  never  learn,  no 
matter  how  much  effort  you  expend  on  him."  Apparently, 
also,  the  teacher  believed  the  mother  who  was  so  candid  about 
the  failings  of  her  son,  accepted  her  advice,  and  spent  her 
energies  on  the  other  children. 

As  might  be  expected  under  the  guidance  of  such  a  mother, 
home  life  was  not  an  aid  to  John's  mental  development.  Julia 
says  that  her  earliest  remembrances  are  of  squalid  surround- 
ings, a  room  or  two  with  the  poorest  of  furnishings,  which 
were  never  anything  but  filthy.  She  had  very  little  clothing, 
and  at  times  such  a  small  amount  that  she  was  forced  to  stay 
indoors.  John  says  that  his  mother  would  buy  him  new  clothes 
and  then  lock  them  up  till  he  had  outgrown  them.  Moreover, 
there  was  never  enough  food,  and  the  children  were  continually 
hungry.  The  mother  and  stepfather  beat  Julia  and  obliged  her 
to  chop  wood  and  do  all  the  work.  In  her  presence  they  also 
indulged  in  perverse  sexual  practices.  John  was  not  abused  to 
the  same  extent,  probably  because  he  was  the   father's  own 


THE    KINGDOM    OF    EVILS  1 85 

child.     However,  the  only  attempt  to  teach  him  anything  was 
his  father's  instruction  in  obscene  verses  and  songs. 

John  and  Julia  had  not  even  the  opportunity  to  learn  from 
contact  with  other  children.  Their  mother  often  kept  them  in 
the  house,  and  this  happened  still  more  frequently  after  the 
father  deserted.  Even  when  the  mother  was  away  scrubbing 
in  the  middle  of  the  day,  the  children  dared  not  venture  out  for 
fear  there  might  be  some  truth  in  their  mother's  statements 
that  "there  was  a  God  overhead  who  would  do  various  things 
to  them,  that  the  policeman  would  get  them  and  do  terrible 
things,  that  people  would  kill  them,"  and  later,  when  Julia 
was  living  elsewhere,  the  mother  told  John  that  "they  would 
jatch  him  in  the  draft," — a  hazy,  but  horrible  fate. 

John's  story  of  his  life  is  of  a  succession  of  moves  from 
house  after  house,  with  periods  of  confinement  varying  from 
a  few  days  to  one  that  lasted  thirteen  months.  Most  of  the 
day  time  he  slept  or  amused  himself  by  reading  the  Bible,  the 
few  religious  books,  and  the  few  Indian  stories  which  they 
owned.  When  the  mother  returned  from  her  work,  he  seems 
to  have  been  occupied  with  endeavoring  to  escape  her  wrath. 
He  says  that  she  would  ask  him  questions  and  then  answer 
them  herself.  H  he  attempted  a  reply,  she  usually  slapped  his 
face.  She  talked  continually  of  the  references  which  the  news- 
papers made  to  her,  and  of  the  pictures  the  moving-picture  men 
were  taking  of  her.  They  had  no  regular  meals.  The  mother 
probably  ate  something  at  the  restaurant  where  she  did  scrub- 
bing, but  all  she  brought  home  to  John  was  bologna  sausage, 
milk,  crackers,  and  bread.  When  he  came  to  this  hospital,  the 
boy  had  not  had  a  hot  meal  in  months.  At  night  he  was  often 
kept  awake  by  his  mother's  talking,  by  what  he  called  "mother's 
lies." 

Things  went  from  bad  to  worse  with  John,  but  they  im- 
proved for  Julia  in  the  spring  of  191 7.  At  that  time  the  mother 
accepted  a  position  as  "an  experienced  cook"  and  took  the 
children  with  her.  On  the  third  day  she  was  discharged  as 
dirty  and  hopelessly  incompetent.  Julia,  however,  was  retained 
and  since  that  time  has  had  normal  surroundings.  John  and 
his  mother  returned  to  their  squalid  living,  and  the  boy  was 
confined  even  more  closely  until  early  in  1918,  when  the  police 
and  one  of  the  children's  societies  found  them  and  brought 
them  both  to  this  hospital. 


1 86  THE    KINGDOM    OF   EVILS 

When  John  was  examined  here,  he  was  a  large,  overgrown 
boy,  sallow  and  anemic.  His  voice  was  husky  and  uncertain. 
He  did  not  know  how  to  meet  strangers,  and  was  shy  and 
reserved.  His  face  was  a  little  sober,  but  almost  expressionless. 
He  smiled  slightly  and  then  only  after  many  interviews.  He 
answered  all  questions  as  briefly  as  possible.  The  most  sur- 
prising thing  about  his  attitude  was  that  he  took  practically 
no  interest  in  his  surroundings  or  in  what  was  to  happen  to  him. 
John's  ignorance  of  the  world  about  him  was  astounding.  He 
could  name  the  president,  the  governor,  and  several  recent 
mayors,  but  when  asked  for  the  capital  of  Massachusetts  he 
did  not  understand  what  was  meant.  He  knew  nothing  what- 
ever of  geography.  With  the  exception  of  reading,  arithmetic 
was  the  only  school  subject  in  which  his  performance  was  at  all 
creditable.  He  had  never  seen  a  moving  picture  or  a  baseball 
game. 

We  have  here,  then,  a  boy  of  fifteen  and  a  half,  who  has 
had  practically  no  school  training,  practically  no  contact  with 
other  children,  and  no  home  education  save  what  he  may  have 
picked  up  from  the  reading  of  a  few  religious  books,  and  per- 
haps a  stray  copy  of  a  newspaper. 

In  spite  of  this  overwhelming  lack  of  information  and  of 
training,  when  given  a  psychological  examination,  John  re- 
ceived a  mental  age  of  16.0  (I.  O.,  104)  on  the  Yerkes- 
Bridges  Point  Scale,  and  a  mental  age  of  15  yr.  i  mo.  (I.  Q., 
.98)  on  the  Stanford  Revision  of  the  Binet.  There  is  nothing 
in  the  examinations  that  would  be  unusual  in  a  normal  boy  of 
his  age.  On  the  Point  Scale  the  errors  he  made  were  in :  repe- 
tition of  seven  digits,  repetition  of  the  longest  sentence,  failure 
to  give  interpretation  for  two  of  the  pictures,  failure  to  give 
definitions  in  terms  of  classification,  acceptance  of  the  line  sug- 
gestion, failure  in  one  of  the  memory  drawings,  in  one  of 
the  definitions  of  abstract  terms,  and  in  one  analogy.  On  the 
Stanford  Scale,  he  passed  all  the  9  year  tests,  failed  in  designs 
from  memory  in  year  10,  an  interpretation  of  pictures  in  year 
12,  in  the  vocabulary  in  year  14  and  the  succeeding  years,  in 
giving  differences  between  abstract  words,  in  repeating  back- 
wards, and  in  the  code  in  year  16,  and  in  the  repetition  of  digits 
forwards  and  backwards  and  in  giving  the  thought  of  a  passage 
in  year  18.     His  arithmetical  ability  is  particularly  evident  in 


THE    KINGDOM    OF    EVILS  187 

the  Stanford  examination.  He  did  the  Healy  Construction 
Puzzle  A  in  seven  moves  in  fifteen  seconds  and  Construction 
Puzzle  B  in  twelve  moves  in  thirty  seconds.  His  attitude  dur- 
ing the  psychological  examination  was  somewhat  listless  and 
a  bit  childish,  but  he  cooperated  well  and  showed  occasional 
interest  and  pleasure. 

The  conclusion  must  be  that,  in  this  case,  at  least,  lack  of 
school  education,  lack  of  home  training,  and  lack  of  normal 
intercourse  with  other  children  have  not  prevented  a  normal 
rating  on  intelligence  scales. 

John's  subsequent  history,  while  not  of  consequence  for  our 
purpose,  is,  nevertheless,  interesting.  He  was  discharged  from 
this  hospital  with  the  diagnosis  "not  insane,  not  feeble-minded." 
We  hoped  that  it  would  be  possible  to  give  an  examination  at 
the  expiration  of  his  first  year  of  living  in  normal  surround- 
ings. This  proved  inadvisable  because  the  boy  is  doing  good 
work  on  a  farm,  and  a  trip  to  the  city  might  encourage  his 
present  ambition  to  work  in  a  store,  a  job  which  doubtless 
would  not  fit  him  just  now.  The  society,  however,  sent  us  a 
detailed  report  of  a  "visit"  made,  and  we  give  the  substance  of 
that  report  here  : — 

John  is  living  on  a  farm  with  a  family  who  understand  his 
case  and  are  anxious  to  assist  him  in  every  way  possible.  He 
has  gained  in  weight  since  last  year  and  he  looks  physically 
well.  However,  he  is  very  slow  in  his  movements,  and  appears 
to  take  no  interest  in  his  surroundings.  He  seemed  little  af- 
fected by  the  fact  that  the  visitor  had  come  from  Boston  to  see 
him,  and  the  family  say  that  this  is  his  usual  attitude.  In  the 
year  that  he  has  been  with  them,  he  has  never  spoken  of  his 
mother  and  sister,  has  never  asked  questions  about  places  to 
which  he  has  been  taken  in  the  automobile,  or  shown  any  inter- 
est in  them.  The  only  exception  was  one  trip  to  the  ocean 
when  he  asked,  "Why  can't  you  see  the  other  side?"  He  has 
never  spoken  of  the  trip  since.  His  typical  day  is  as  follows: 
Rises  at  six  without  being  called,  feeds  the  horses  without 
being  told,  milks  three  cows,  comes  into  the  house  for  breakfast 
without  being  called,  eats  a  hearty  breakfast,  then,  without  any. 
comment,  returns  to  work,  waters  the  cows,  and  cleans  up  the 
barn.  He  comes  back  to  the  house  about  meal  time,  gets  the 
mail  from  a  box  at  the  end  of  the  lane  without  reading  any 
addresses  or  ever  asking  if  there  is  a  letter  for  him.    After  the 


1 88  THE    KINGDOM    OF    EVILS 

noon  meal  he  takes  care  of  the  hens  and  does  odd  jobs.  In  the 
summer  time  he  goes  for  the  cows.  After  supper  he  reads  the 
jokes  in  the  daily  paper  and  Farm  Journal,  sometimes  smiling 
a  little.  He  never  grumbles  while  doing  anything  he  is  asked, 
never  asks  a  question,  very  seldom  speaks  without  being  spoken 
to,  goes  to  bed  without  being  told  to  at  six-thirty  and  is  per- 
fectly willing  to  do  this  day  in  and  day  out.  In  fact,  far  from 
disliking  routine,  he  is  somewhat  disturbed  when  rain  prevents 
the  performance  of  some  of  his  usual  chores.  He  shows  no 
interest  in  anything.  He  is  good  to  the  animals  but  never  pets 
them  and  the  dog  and  cat  never  ask  him  for  food.  He  never 
notices  anything  unusual.  If.  for  example,  a  cow  were  in  great 
distress  and  he  had  not  been  told  to  notice  whether  or  not  the 
cow  was  sick,  he  would  make  no  comment.  Neither  is  he  at 
all  interested  in  the  fact  that  the  farmer  is  willing  to  give  him 
fifty  dollars  if  he  remains  with  him  a  full  year.  Besides  this 
total  indifiference,  the  farmer  and  his  wife  have  reported  sev- 
eral facts  which  are  of  importance  in  the  prognosis  of  the  case. 
He  has  recently  been  smiling  more  often,  and  occasionally 
laughs  heartily  when  alone  at  his  work.  When  asked  what 
he  was  amused  at,  he  insists  that  he  did  not  laugh.  He  has 
never  made  any  attempt  to  play  with  a  boy  who  lives  in  the 
next  house,  a  quarter  of  a  mile  away.  It  seems  likely  that  the 
boy  may  end  by  having  dementia  praecox,  like  his  mother. 

From  the  above  account  as  published  by  Dr.  Foster,  it  will 
be  seen  that  our  initial  idea  in  presenting  John  Henry ;  namely, 
that  he  might  be  regarded  as  an  instance  of  purely  educational 
deficiency  minus  all  four  other  forms  of  social  defect  that  we 
classified  in  this  book,  medical,  moral,  legal,  and  economic,  is 
destined  to  prove  unsound.  Perhaps,  in  short,  we  did  regard 
John  Henry  as  a  combination  of  psychopathic  trend  and  educa- 
tional defect.  He  brings  out  so  purely  and  picturesquely,  how- 
ever, what  lack  of  education  cannot  do  that  we  have  determined 
to  keep  him  in  his  place  in  the  series  to  portray  a  singularly 
simple  instance  of  educational  deficiency. 

Hours  spent  by  Medical  record,  25  pages 

Social  record,  0  pages 
Physician,  4V2  Social  work: 

Visits,  0 
Psychologist,  1  Interviews  at  hospital,  o 

Telephone  calls,  o 
Social  worker,  o  Letters,  o 


THE    KINGDOM    OF    EVILS  189 

Girl  who  fabricated  and  ran  away  from  home.  Mother  of 
two  illegitimate  children. 

Case  36.  Clara  Perkins'  difficulties  are  all  in  the  moral 
sphere.  She  was  an  average  scholar,  graduating  from  the 
grammar  school  at  fourteen;  and  she  qualified  for  entrance  to 
a  nurses'  training  school,  where  she  spent  a  few  months  in 
training.  She  had  had  no  difficulty  in  supporting  herself ;  and 
her  family,  although  they  find  it  hard  to  make  both  ends  meet, 
manage  to  keep  out  of  debt.  With  public  authorities  Clara  has 
had  no  contact.  When  she  was  under  observation  in  the  Psy- 
chopathic Hospital  at  the  age  of  eighteeen,  the  diagnosis  made 
was  psychopathic  personality ;  but  after  she  had  been  under 
supervision  for  a  year  and  a  half,  the  opinion  of  the  physician 
in  charge  of  the  out-patient  department  was  that  this  diagnosis 
was  a  mistake.  He  considered  her  normal  and  sufficiently 
stable  to  undertake  nurse's  training.  By  psychological  tests 
she  graded  at  adult  age  and  did  still  better  in  the  supplemen- 
tary tests  upon  another  examination  a  year  after  the  first. 

The  cause  of  her  examination  at  the  Psychopathic  Hospital 
was  a  series  of  fabrications  that  began  about  a  year  earlier. 
The  following  account  is  taken  from  the  social  record : — 

Since  January,  191 5,  patient  has  systematically  and  success- 
fully deceived  her  mother  and  associates  as  to  the  work  she  has 
been  doing.  To  her  employer  and  fellow  employees  she  told 
stories  of  being  engaged,  of  the  abuses  of  her  parents  who  had 
"sold  her  into  virtual  slavery"  at  fifteen  to  a  man  by  whom 
she  had  a  child.  She  told  of  being  an  illegitimate  child  herself. 
To  her  dentist  she  told  elaborate  tales  of  abuses  by  her  parents 
and  the  discovery  of  her  real  father.  She  maintained  the 
family  were  trying  to  force  her  to  marry  someone  she  did  not 
want  to.  To  her  family  and  neighborhood  friends  she  gave 
minute  details  of  her  nurse's  training  course  and  the  visiting 
nursing  among  the  poor  which  she  was  doing.  She  stayed 
away  from  home,  ten  days  at  Hotel  Cambridge  and  three  or 
four  days  at  Tremont  Street  lodging  house,  on  a  pretext  of 
being  "on  cases."  She  wrote  two  long  letters  to  her  dentist 
and  once  sent  for  him  to  see  her  at  Hotel  Cambridge  which  he 
did.  To  her  family  and  to  employers'  children  she  introduced 
some  man  by  different  names.  She  explains  later  this  was  a 
chauffeur  friend  of  a  girl  working  in  neighborhood.  No  other 
suggestion  or  positive  history  of  sex  delinquency. 


IQO  THE    KINGDOM    OF   EVILS 

During  this  period  of  lying  patient's  habits  were  as  regular  as 
before.  She  left  her  place  of  employment  to  be  married  she 
said,  and  her  mother's  telephoning  there  to  find  out  where  she 
was  disclosed  the  truth.  Patient  went  constantly  to  moving 
pictures  and  could  remember  a  film  a  year  back  as  vividly  as 
though  she  had  just  seen  it.  They  affected  her  so  much  that 
she  imagined  herself  as  playing  some  of  the  parts. 

Clara's  father  had  been  alcoholic  for  a  time  and  her  paternal 
grandfather  and  great-grandfather  were  insane.  Her  mother 
comes  of  good  stock,  but  is  a  delicate  "nervous"  woman.  The 
other  children,  three  little  brothers,  are  well.  A  half-sister  and 
a  half-brother,  who  live  in  the  city,  are  married  and  successful, 
and  take  a  good  deal  of  interest  in  Clara.  Except  for  the 
narrow  limits  of  the  family  income  (Mr.  Perkins  earned  about 
fifteen  dollars  in  a  garage)  Clara's  home  life  should  have  been 
on  the  whole  comfortable  and  happy.  They  had  been  in  more 
comfortable  circumstances  in  Nova  Scotia,  but  Mr.  Perkins 
lost  his  position  through  drink,  and  so  nine  years  before  they 
had  come  to  Boston  for  a  new  start.  Mrs.  Perkins  had  always 
"kept  a  girl"  and  had  not  been  used  to  the  heavy  work  in  the 
house  that  she  now  had  to  do.  Mr.  Perkins  no  longer  drank 
to  the  point  of  intoxication,  but  enough  to  affect  his  disposition 
at  home.  Clara  was  very  fond  of  her  family  but  afraid  of  her 
father  and  jealous  of  his  attention  to  the  younger  children. 
She  was  very  affectionate  and  would  sometimes  cry  if  she  did 
not  receive  the  attention  she  desired.  With  her  mother  she 
often  got  into  little  quarrels,  as  both  were  quick-tempered,  and 
Clara  was  apt  to  feel  that  her  mother  did  not  understand  her. 
She  never  went  out  in  the  evening  and  had  no  girl  friends  ex- 
cept her  half-sister  and  sister-in-law;  and  she  had  never  "gone 
out"  with  young  men.  The  home  was  neat  and  pleasant,  but 
she  was  ashamed  of  it,  because  "the  stair  carpet  had  been  taken 
up"  and  not  replaced. 

After  leaving  school  Clara  worked  in  eight  different  places 
within  four  years  as  bundle  girl,  laundry  worker,  and  nurse- 
maid. She  was  never  discharged  but  changed  about  from  rest- 
lessness. She  had  no  ambition  except  a  vague  desire  to  become 
a  nurse. 

When  she  left  the  hospital  she  was  taken  to  a  general  hos- 
pital for  the  removal  of  tonsils  and  adenoids  and  after  some 
weeks  in  a  convalescent  home  was  gotten  a  position  in  a  laun- 


THE    KINGDOM    OF   EVILS  IQI 

dry.  Her  eyes  were  examined  for  glasses  and  a  fallen  arch 
was  strapped  at  a  general  dispensary.  After  a  few  months  she 
left  her  position  when  a  raise  of  wages  was  refused,  and  for 
several  days  went  about  the  city  looking  for  work  and  conceal- 
ing her  unemployment.  After  this  she  seemed  physically  tired 
and  could  give  no  clear  account  of  how  she  had  spent  the  time. 
This  was  the  only  recurrence  of  her  deceptiveness  until  over 
three  years  later,  when,  a  year  after  the  case  had  been  closed, 
her  mother  came  to  us  in  alarm  because  Clara  had  "begun  her 
fabrications"  again.  She  had  been  telling  extravagant  false 
stories  about  her  half-sister  with  whom  she  was  living,  which 
stopped  at  once  when  she  heard  that  her  mother  had  consulted 
the  hospital. 

Work  away  from  home  was  tried  next  and  a  position  as 
maid  in  a  small  out-of-town  hospital  obtained  for  her.  She 
gave  satisfaction  in  her  work  and  was  advanced  to  greater 
responsibility.  Her  conduct  was  satisfactory  also.  Two  young 
men  whom  she  met  in  the  town  proposed  to  her  and  her  attitude 
toward  them  seemed  to  be  sensible  and  dignified.  To  one  of 
them  she  was  about  to  become  engaged  when  he  enlisted  and 
was  sent  to  France.  Clara  decided  not  to  be  formally  engaged 
to  him  until  his  return.  She  wanted  very  much  to  enter  a  train- 
ing school  for  nurses  and  was  not  opposed.  After  a  few  months 
she  was  doing  so  well  that  we  felt  we  could  close  the  case.  We 
were  influenced  in  this  decision  by  the  fact  that  the  social 
worker  who  had  dealt  with  Clara's  case  from  the  beginning  was 
leaving.  Although  we  felt  that  another  year  of  supervision 
would  be  required  before  we  could  feel  satisfied  that  Clara  was 
in  a  stable  condition,  between  the  difficulty  of  introducing  a 
new  social  worker  to  the  case  and  the  pressure  of  new  work, 
we  decided  to  close  the  case,  unwisely  as  the  event  showed. 
We  inquired  of  Mrs.  Perkins  in  December,  1918,  and  were 
told  that  Clara  was  doing  well;  that  she  had  given  up  the 
nurse's  training  which  proved  to  be  too  hard  for  her,  but  was 
working  in  a  mill  and  living  with  her  half-sister,  and  that  she 
heard  from  the  young  man  in  France  who  had  asked  her  "to 
wait  for  him."  When  three  months  later  the  family  were 
alarmed  at  signs  of  a  returning  tendency  to  fabricate  and  Mrs. 
Perkins  came  to  us  for  advice,  she  told  the  real  reason  for 
Clara's  leaving  the  training  school — she  had  become  pregnant. 

When  she  left  the  maternity  home  where  she  was  confined, 


192  THE    KINGDOM    OF    EVILS 

she  boarded  the  baby  with  a  friend  of  her  mother  and  went  to 
live  with  her  half-sister,  whose  husband  was  willing  to  have 
the  baby  come,  too,  when  it  should  be  a  little  older  and  less 
care.  Clara  claimed  that  she  had  written  the  whole  story  to  a 
soldier  in  France  to  whom  she  was  "half  engaged"  and  that  he 
had  replied  in  a  fashion  that  led  her  to  hope  he  still  expected 
that  they  would  be  married.  The  case  was  reopened  for  super- 
vision of  the  baby's  health  (the  child  was  found  to  be  in  poor 
condition),  of  Clara's  health  (for  she  had  been  having  more 
trouble  with  the  arches  of  her  feet),  and  to  steady  Clara  during 
this  period,  while  she  was  expecting  the  return  of  her  fiance. 

When  the  soldier  returned,  however,  he  disclaimed  an 
engagement  to  Clara  and  married  another  girl.  In  the  mean- 
time Clara  had  become  pregnant  again.  The  only  account  of 
the  parenthood  of  this  child  that  could  be  obtained  was  her 
story  of  an  assault.  The  first  baby  she  placed  for  adoption 
against  our  advice,  and  with  the  second  baby  she  went  to  nurse 
during  confinement  the  wife  of  the  young  soldier  to  whom  she 
had  claimed  to  be  engaged.  She  filled  this  position  with  a 
good  deal  of  ability,  and  when  her  services  were  no  longer 
needed,  she  went  with  her  baby  to  keep  house  for  a  small 
family  at  their  summer  home  in  the  country.  Here  she  is 
well  liked  and  is  highly  commended  for  her  ability  in  cooking 
and  managing. 

Hours  spent  by  Medical  record,  38  pages 

Social  record,  54  pages 
Physician,  7  Social  work: 

Visits,  38 
Psychologist,  2  Interviews  at  hospital,  53 

Telephone  calls,  15 
Social  worker,  69  Letters,  13 


Overfrugal  tailor  in  court  for  non-support.  Attention  of 
legal  authorities  to  social  and  medical  facts. 

Case  37.  Perhaps  the  Psychopathic  Hospital  should  not 
have  handled  such  a  case  as  Nathan  Blumberg,  presented  as  a 
paradigm  of  relatively  pure  legal  difficulty.  Yet  we  can  readily 
show  a  dark  reflex  of  legal  trouble  upon  several  other  sides  of 
the  man's  life.     In  no  sense  of  heroic  proportions,  just  such 


THE    KINGDOM    OF    EVILS  193 

gray  or  drab  difficulties  form  the  stock-in-life  of  a  number  of 
"normal  enough"  persons,  whose  best  aid  will  probably  turn 
out  to  be  aid  from  social  psychiatry.  As  in  novels  of  Balzac 
the  characteristic  legal  troubles  not  unreadily  find  a  psycho- 
pathic figure  in  their  midst  or  at  least  a  figure  which  has  a 
soitpgon  of  mental  disease  about  it,  so  in  cases  like  Blumberg's. 
Blumberg  was  even  at  one  time  provisionally  classified  as 
falling  in  the  group  of  psychoneurotics,  but  on  the  v/hole  no 
satisfactory  diagnosis  of  the  sort  can  be  offered,  or  perhaps 
any  psychiatric  diagnosis. 

Amongst  the  social  symptoms  in  case  Blumberg  we  find  such 
items  as  the  following :  arrest,  separation  from  family,  partial 
industrial  disability,  unemployment,  family  dissension.  In 
point  of  fact,  Blumberg  was  never  seriously  disabled,  indus- 
trially speaking,  save  as  the  immediate  result  of  his  legal 
tangles. 

Blumberg  was  a  Russian  Jew,  one  of  twelve  siblings.  There 
were  apparently  no  psychopathic  or  especially  neurotic  features 
in  his  family.  He  had  not  attended  school  in  Russia  and  main- 
tained that  there  were  no  schools  where  he  was  born.  Never- 
theless, he  had  in  America  learned  to  read  English.  He  had 
learned  tailoring  from  his  father  in  Russia.  He  had  been  in 
the  Russian  Army  before  the  Russo-Japanese  War  and  came 
to  America  in  1904  to  escape  service  in  the  army.  He  had 
already  married  at  the  age  of  twenty-six  a  quarrelsome  wife, 
from  (as  he  said)  a  quarrelsome  family.  He  came  to  America 
without  his  wife.  Finally,  in  the  course  of  eighteen  months, 
he  sent  for  his  wife.  He  had  now  become  a  bushelman  tailor. 
Soon,  however,  the  wife's  complaints  about  money  and  her 
extravagance  began  to  grate  on  Blumberg,  who  himself  had 
an  ambition  to  save  every  cent.  He  loaned  money  to  a  pros- 
perous brother-in-law,  but  when  he  tried  to  get  the  money  back 
a  year  later,  he  found  that  his  wife  was  spending  some  of  it. 
By  the  time  the  whole  of  the  money  was  returned,  Mrs.  Blum- 
berg had  bought  a  fur  coat  with  two  hundred  dollars  of  the 
sum. 

Then  came  quarrels.  Once  the  Blumbergs  came  to  blows. 
According  to  Blumberg,  his  wife  struck  him  first,  as  she 
"would  not  take  him  right."  Blumberg  was  forthwith  arrested 
and  was  triumphantly  informed  by  his  wife  that  "in  this  coun- 
try a  lady  can  do  as  she  pleases."     The  case  was  filed,  but  he 


194  THE    KINGDOM    OF    EVILS 

moved  to  another  city  whither  his  wife  followed  him  some 
months  later.  With  Blumberg's  money  Mrs.  Blumberg  started 
to  run  a  shop  with  one  of  the  boarders  that  she  had  been 
taking.  Blumberg  became  suspicious  that  his  wife  was  not 
true  to  him,  but  the  suspicion  was  rather  of  her  general  loyalty 
than  of  any  sex  delinquency.  Now  shortly  the  wife  began  a 
suit  for  separate  maintenance,  and  the  newspaper  publicity 
caused  him  again  to  remove,  this  time  with  two  of  his  children, 
to  a  relative's  farm.  Then  came  the  decree  that  he  pay  fifteen 
dollars  a  week  for  the  support  and  care  of  his  children  and 
that  meantime  all  the  children  should  live  with  the  wife,  but 
visit  Blumberg  with  reasonable  frequency. 

Blumberg  had  not  of  late  been  working  steadily.  He  finally 
appeared  at  the  Psychopathic  Hospital  out-patient  department, 
coming  alone  and  complaining  that  for  the  past  year  he  had 
often  been  chilly  all  over,  that  he  had  had  pains  in  all  his  bones 
and  dizziness  in  his  head  which  was  worse  on  windy  days,  that 
he  had  slept  poorly,  that  he  had  had  bad  dreams  and  was  sweat- 
ing profusely  at  night. 

Upon  investigation  it  appeared  that  the  cause  of  the  legal 
entanglements  was  chiefly  financial,  due  to  a  conflict  between 
Blumberg's  ambition  to  save  and  Mrs.  Blumberg's  contrary 
ideal.  Blumberg  could  not  pay  the  maintenance  allowance.  It 
is  somewhat  edifying,  though  not  amusing,  to  find  that  when 
Blumberg  could  not  pay  the  allowance,  he  was  adjudged  (after 
some  correspondence)  to  be  under  contempt  of  court  and 
actually  was  committed  to  jail  until  he  should  pay  one  hundred 
dollars.  He  was  bailed  out  two  days  later  and  fled  to  New 
York  City.  He  wrote  asking  what  he  should  do  next,  was 
advised  to  return  and  try  to  make  it  up  with  the  court  and 
did,  in  fact,  come  back  to  Boston;  but  before  he  could  be  seen 
by  the  physician  with  whom  he  was  on  friendly  terms,  he 
walked  out  and  has  not  since  been  heard  of. 

It  is  a  question  in  our  minds  whether  what  might  be  termed 
the  "frightfulness"  of  the  jail  order  has  not  tended  to  sever  con- 
nections completely  between  Blumberg  and  his  family.  Some- 
times inexperienced  courts  talk  about  "these  cases"  without,  so 
far  as  we  are  aware,  defining  to  what  group  ''these  cases"  ac- 
tually belong.  We  are  not  ourselves  sure  that  we  are  dealing 
fundamentally  with  a  "case,"  medically  speaking.  A  case  with 
such  indefinite  mental  symptoms  or  features  suggests  that  pro- 


THE    KINGDOM    OF    EVILS  I95 

found  allowances  should  be  made  for  errors  in  handling;  much 
hangs  on  whether  Blumberg  is  psychoneurotic  or  is  not  psycho- 
neurotic. It  seems  clear  that  his  legal  handling  has  not  been 
based  upon  as  thorough  a  knowledge  of  the  everyday  facts  as 
lay  directly  at  the  hand  of  the  court. 

It  is  not  that  the  wife's  story  was  particularly  appealing  in 
contrast  to  Blumberg's,  for  no  one  has  asserted  that  Mrs. 
Blumberg's  moral  attitude  was  of  the  most  exquisite.  Our 
present  point  simply  reduces  to  the  feeling  that  proper  atten- 
tion is  not  always  paid  by  legal  authorities  to  social  and  medi- 
cal facts.  Nor  will  it  much  longer  serve  for  the  legal  authorities 
in  these  modern  days  to  justify  themselves  by  the  vague  gener- 
ality that  we  lawyers  understand  these  things  whereas  you  lay- 
men exist  in  the  penumbra.  We  are  bound  to  say  that  some- 
times these  matters  are  not  attended  to  in  extcnso  and  in  all 
their  profundities  by  the  judges  themselves,  but  rather  by  the 
clerks  of  courts  and  probation  officers,  some  of  whom  are  not 
yet  educated  (even  by  prolonged  "practical"  experience)  in 
psychiatric  social  work. 

Hours  spent  by  Medical  record,  6  pages 

Social  record,  16  pages 
Physician,  4Y2  Social  work: 

Visits,  I 
Psychologist,  o  Interviews  at  hospital,  6 

Telephone  calls,  i 
Social  worker,  9  Letters,  24 


Poor  old  woman,  zvorried  and  overworked. 

Case  38.  Though  Margaret  Dolan  came  to  us  as  a  patient, 
her  difficulties  were  almost  entirely  financial.  The  medical 
opinion  after  she  had  been  observed  for  ten  days  in  the  hospital 
was  "not  psychotic."  Her  mental  condition  was  the  result  of 
well-founded  worry.  For  nine  months  she  had  been  in  con- 
siderable anxiety  about  debts,  doctors'  bills,  and  even  the 
means  of  subsistence.  She  suffered  from  indigestion,  which 
four  doctors  in  turn  had  not  been  able  to  relieve,  and  was 
afraid  to  eat  for  fear  of  increasing  her  stomach  trouble.  She 
was  afraid  that  she  would  go  insane  and  spoke  of  feelings  of 
unreality,  saying  "I  feel  I  am  way  ofif  in  some  other  world." 


196  THE    KINGDOM    OF    EVILS 

Educationally  Margaret  was  not  lacking, — after  graduating 
from  high  school,  she  had  studied  bookkeeping;  and  she  was 
far  removed  from  conflict  with  public  authorities.  But  her 
financial  difficulties  loomed  large. 

She  was  fifty-two  years  old,  and  her  sister  Annie,  with  whom 
she  lived,  was  fifty-nine.  They  were  two  gentle  little  old  ladies, 
of  frail  physique  and  brave  hearts.  Annie  was  the  more 
optimistic  and  had  "always  looked  on  the  bright  side  of  things" 
but  Margaret  always  worried  a  bit.  They  took  two  lodgers  in 
their  tiny  apartment  and  while  Margaret  did  the  housework 
Annie  worked  in  a  shoe  factory,  getting  from  seven  to  twelve 
dollars  a  week.  In  this  way  they  were  able  to  have  a  more 
comfortable  home  than  if  Margaret,  too,  had  gone  to  the  shoe 
factory.  She  had  expected  to  be  a  bookkeeper,  but  soon  after 
she  took  her  first  position  she  was  called  back  home  to  nurse 
■her  mother  through  an  illness  of  years,  and  again  after  working 
for  a  short  time  went  home  to  nurse  her  father  until  his  death. 
■fifteen  years  ago.  Then  she  and  her  sister  came  to  the  city 
to  keep  house  for  their  brother.  He  drank  heavily  and  finally 
eight  years  before  had  disappeared.  The  sisters  continued  to 
keep  their  home  and  got  along  comfortably,  until  Annie  was 
laid  ofif  during  a  slack  season,  one  of  the  lodgers  left,  and  Mar- 
garet began  to  have  indigestion.  For  doctors'  bills  for  Mar- 
garet and  living  expenses  they  had  gradually  borrowed  two 
hundred  and  fifty  dollars  and  they  could  barely  meet  their  living 
expenses.  They  could  not  afiford  to  pay  for  the  refitting  of 
Margaret's  artificial  teeth,  which  did  not  fit  properly  and 
caused  her  difficulty  in  chewing. 

After  reassurance  and  three  weeks'  rest  in  the  country,  and 
a  new  plate  for  the  teeth,  Margaret  had  gained  fourteen  pounds 
and  felt  much  better.  It  was  several  months  before  she  would 
venture  alone  on  the  street.  She  held  two  hundred  and  fifty 
dollars  life  insurance  for  her  brother,  whom  the  sisters 
believed  to  be  dead.  This  money  was  finally  secured  through 
a  friendly  lawyer  to  pay  ofif  the  debt  that  was  worrying  them. 
Lighter  work  was  to  be  found  for  Annie,  as  army  shoes  made 
heavy  work  for  the  frail  little  woman ;  but  she  developed  cancer 
and  soon  had  to  be  sent  to  a  hospital  where  she  died  in  a  few 
months.  Aid  from  a  relief  society  was  obtained  for  Margaret, 
who  kept  the  home  and  visited  her  sister  every  day  in  the 
hospital.     After  Annie's  death,  she  was  well  enough  to  take 


THE    KINGDOM    OF    EVILS  I97 

a  position  at  housework.  During  her  sister's  illness  many  of 
her  old  friends  renewed  their  interest  in  her.  She  no  longer 
had  a  sense  of  unreality  or  feared  to  go  about  alone  and  seemed 
quite  capable  of  taking  care  of  herself. 

Hours  spent  by  Medical  record,  17  pages 

Social  record,  27  pages 
Physician,  8  Social  work: 

Visits,  47 
Psychologist,  o  Interviews  at  hospital,   10 

Telephone  calls,  64 
Social  worker,  90J/2  Letters,  25 


BOOK  III 


Oh  that  my  vexation  were  hut  weighed, 
And  all  my  calamity  laid  in  the  balances. 

Job,  Chapter  6,  Verse  2. 


ELEVEN  MAJOR  GROUPS  OF  MENTAL  DISEASES 


Illustrated  in  Sixty-two  Specimen  Cases  of 
Psychiatric  Social  Work 


I.     General    paresis,    juvenile 

paresis,  etc. 
II.     Feeble-mindedness  of  vari- 
ous forms. 

III.  Epilepsies. 

IV.  Alcoholic,        drug,        and 

poison  cases. 
V.     Focal    brain    lesion    cases 

(mental). 
VI.     "Symptomatic"         mental 
cases  (bodily  origin). 
VII.     Senile,       senescent,      pre- 
senile  cases    (old   age 
group). 
VIII.     Dementia    praecox;    para- 
phrenia. 
IX.     Manic-depressive  psy- 

choses ;  cyclothymic. 
X.     Hysteria,        neurasthenia, 
psychasthenia. 
XL     Dubious   and   special   psy- 
chopathias. 


Syphilopsychoses 

Hypophrenoses 

Epileptoses 
Pharmacopsychoses 

Encephalopsychoses 

Somatopsychoses 
Geriopsychoses 

Schizophrenoses 
Cyclothymoses 
Psychoneuroses 
Psychopathoses 


Note. — This  book  is   intended  to   give  the  physician  a  general  view  of 
the  social-psychiatric  problems  in  the  main  mental  disease  groups. 


SECTION   I 

SYPHILOPSYCHOSES    ( NEUROSYPHILIS) 

Costly  delay  of  diagnosis  in  a  case  of  general  paresis  that 
looked  like  neurasthenia.  Industrial  disability  for  five  years. 
Social  work — free  treatment  and  home  care. 

Case  39.  We  begin  now  to  present  social  cases  from  the 
medical  point  of  view.  The  psychiatric  social  worker  (and 
eventually  the  layman  too)  must  learn  that  insanity  is  not  a 
unit.  There  can  be  no  better  way  of  grasping  the  fact  that 
insanit)',  though  legally  a  unit,  is  not  medically  a  unit,  than 
by  considering  cases  of  syphilis  of  the  nervous  system  (briefly 
put,  neurosyphilis)  giving  rise  to  mental  symptoms. 

We  may  begin  with  the  case  of  Greeley  Harrison,  a  case 
already  presented  from  the  medical  point  of  view  in  the  case 
history,  Neurosyphilis  by  Southard  and  Solomon,  191 7  (case 
9  in  that  collection).  These  authorities  put  Greeley  Harrison 
first  in  every  account  of  the  systematic  diagnosis  of  the  main 
forms  of  neurosyphilis  because  they  desired  to  impress  the  med- 
ical profession  with  the  costly  delay  of  diagnosis  in  that  form 
of  neurosyphilis  known  as  general  paresis. 

''W^hy  was  not  I  told  that  my  disease  was  syphilis  five  years 
ago?"  Harrison  was  wont  to  say  after  he  had  come  under  medi- 
cal treatment  at  the  Psychopathic  Hospital  at  the  age  of  forty- 
six.  In  point  of  fact,  we  found  that  for  a  number  of  years 
past  there  had  been  symptoms  which  should  have  attracted 
medical  attention.  Five  years  before  he  came  to  our  observa- 
tion, namely,  at  the  age  of  fort\'-one,  Harrison  had  been  ap- 
parently overcome  when  working  near  a  stove,  and  afterwards 
went  upstairs,  talking  incoherently.  However,  he  recovered 
shortly,  and  nothing  was  thought  of  the  episode.  Spells  oc- 
curred almost  every  month  for  a  time,  and  later  still  more 
frequently.  Finally  these  spells  became  associated  with  uncon- 
sciousness and  with  loss  of  memory. 

It  is  no  part  of  the  task  of  this  book  to  give  the  details  of 

203 


204  THE    KINGDOM    OF    EVILS 

medical  diagnosis  or  treatment.  From  the  standpoint  of  the  lay 
observer,  the  fact  was  outstanding  that  Harrison  had  for  five 
years  been  unable  to  do  regular  work.  What  misled  the  medical 
inquirer,  and  this  is  a  lesson  for  physicians  and  laymen  in  all 
forms  of  mental  disease  as  well  as  in  the  present  form,  was 
that  Harrison's  constant  complaining  would  set  him  down  as  a 
kind  of  neurasthenic  or  psychasthenic.  It  would  be  stretching 
a  point  to  say  that  his  ideas  were  delusions,  that  is,  demonstra- 
bly false  beliefs,  but  he  continually  dwelt  upon  bodily  symp- 
toms, after  the  manner  of  the  psychoneurotic  (under  the  so- 
called  psychoneuroses  the  psychiatrist  is  apt  to  include  neuras- 
thenia and  hysteria).  Harrison  approached  sundry  physicians 
for  aid,  complaining  of  nervous  indigestion  of  years'  standing, 
of  headache,  of  insomnia,  of  nervousness,  of  failing  memory, 
and  of  deafness.  After  one  knew  that  Harrison  was  a  neuro- 
syphilitic  it  was,  of  course,  easy  to  point  out  that  headache  and 
failing  memory  might  well  have  suggested  syphilis.  However, 
a  number  of  physicians  told  him  that  he  was  a  neurasthenic, 
and  when  he  arrived  at  the  Psychopathic  Hospital  he  announced 
that  neurasthenia  was  the  disease  from  which  he  was  suffering 
and  that  he  had  been  treated  for  this  disease  by  hypophosphites. 
The  so-called  six  tests  (blood  serum  Wassermann,  spinal  fluid 
Wassermann,  globulin  and  albumen  reactions  of  spinal  fluid, 
cell  count  and  gold  sol.  on  spinal  fluid)  proved  positive.  The 
medical  diagnosis  seemed,  beyond  much  question,  to  be  that 
of  general  paresis. 

The  medical  lessons  of  this  case  are: — 

I.  Neurosyphilis,  even  in  its  paretic  form  (so-called  general 
paresis  or  "softening  of  the  brain")  may  look  to  the  physi- 
cians like  that  purely  functional  disease,  neurasthenia. 
(For  an  example  of  pure  neurasthenia  see  below,  case  87.) 
2.  Neurosyphilis,  in  its  paretic  form,  is  not  necessarily  com- 
pletely intractable  to  treatment.  (This  is  a  most  important 
conception,  not  yet  well  established  in  the  medical  mind.) 
And  on  account  of  the  doubt  which  prevails  concerning 
general  paresis  and  its  inevitable  non-responsiveness  to 
treatment,  we  shall  need  to  look  further  into  the  medical 
history  of. case  Harrison. 

.  Harrison  has  had  a  great  deal  of  antisyphilitic  treatment 
including  mjections  into  the  ventricles  of  the  brain.  He  has 
continued  in  about  the  same  state  mentally :  that  is,  there  is  a 


THE    KINGDOM    OF    EVILS  205 

considerable  degree  of  deterioration  and  he  has  occasional 
seizures.  He  is  in  a  state  hospital  where  he  has  charge  of  the 
patients'  dining-room.  Physically  he  is  in  rather  good  condi- 
tion. His  laboratory  tests  are  now  quite  normal.  He  seems 
to  have  been  held  stationary  for  the  past  four  years. 

The  social  work  consisted  in  getting  Harrison  free  treatment, 
encouraging  his  mother,  and  seeing  for  how  long  he  could 
receive  suitable  care  at  home.  His  mother  and  sister  worked 
and  supported  him.  He  had  used  up  considerable  savings 
when  he  came  to  us  and  had  nothing  of  value  left  except  a  fur 
coat. 

Hours  spent  by  Medical  record,  55  pages 

Social  record,  i  page 
Physician,  23^2  Social  work: 

Visits,  o 
Psychologist,  I  Interviews  at  hospital,  6 

Telephone  calls,  o 
Social  worker,  3  Letters,  0 


Widow  with  syphilis  contracted  from  an  abusive  husband. 
Well  for  fourteen  years.  Now  marked  depression.  Treatment, 
rest,  employment. 

Case  40.  Another  case  from  Southard  and  Solomon's 
Neurosyphilis,  Greta  Meyer,  (107  of  that  collection)  is  one 
of  neurosyphilis,  not  of  the  type  of  so-called  general  paresis  or 
"softening  of  the  brain"  but  of  a  more  diffuse  type  of  disease, 
or,  as  commonly  termed  in  medicine,  "cerebrospinal  syphilis." 

This  widow  of  fifty-one  came  of  her  own  volition  to  the 
Psychopathic  Hospital  wanting  aid  from  the  physicians  for  a 
marked  depression.  It  seems  that  she  had  lain  down  one  day 
for  a  nap  and  on  waking  up  found  that  she  could  move  her 
right  arm  and  leg  only  with  great  difficulty.  She  got  much  bet- 
ter in  a  few  days. 

Going  back  in  her  history,  it  appeared  that  two  years  before, 
at  forty-nine,  a  small  swelling  had  appeared  on  the  right  side 
of  the  forehead  near  the  hair  line,  a  swelling  that  was  firm  and 
not  sore.  Treatment,  evidently  antisyphilitic,  reduced  this 
swelling  but  left  a  hollow  space  in  the  bone. 

Going  still   farther  back  in  her  history,   it   appeared  that 


206  THE    KINGDOM    OF   EVILS 

some  sixteen  years  before  her  coming  to  the  Psychopathic 
Hospital,  namely  at  the  age  of  thirty-five,  she  had  developed 
some  red  spots  on  her  hand  which  she  learned  at  a  hospital 
were  due  to  syphilis.  She  was  treated  rather  faithfully  for 
these  spots  for  a  year's  time,  whereupon  she  seemed  perfectly 
well  and,  in  fact,  remained  perfectly  well  for  fourteen  years. 
Going  still  farther  back  in  Mrs.  Meyer's  history,  it  seems  that 
she  was  married  at  sixteen  and  lived  with  her  husband  until 
twenty-nine,  but  at  this  time  she  left  him  on  account  of  his 
being  alcoholic  and  abusing  her,  and  on  account  of  her  dis- 
covering, through  his  physician,  that  he  was  sufifering  from  a 
venereal  disease. 

As  is  mentioned  more  in  exfenso  in  the  Neurosyphilis  case 
history  book,  the  diagnosis  of  a  diffuse  neurosyphilis,  possibly 
associated  with  a  plugging  of  arteries,  was  then  made. 

After  she  had  improved  under  salvarsan  treatment,  she  then 
became  also  a  problem  for  social  workers  in  certain  respects. 
She  was  referred  to  the  social  workers  for  employment  and 
rest.  She  was  accordingly  given  some  three  weeks  of  rest  in  a 
convalescent  home.  Some  temporary  jobs  were  then  secured. 
The  depression  for  which  she  had  originally  consulted  the  hos- 
pital was  greatly  diminished  during  this  treatment  by  rest  and 
employment.  The  case  could  then,  for  a  period  of  about  a 
year,  be  closed  by  the  social  workers  and  then  referred  to  the 
follow-up  division  of  our  department  to  insure  the  proper  con- 
tinuance of  medical  treatment.  An  incident  of  her  care  was 
that  about  six  months  after  her  original  treatment  for  syphilis 
she  slipped  on  a  wet  floor  and  fell,  fracturing  the  pelvis.  (The 
bones  of  some  syphilitics  are  well  known  to  be  rather  more 
susceptible  to  fracture  than  those  of  normal  persons.) 

From  the  standpoint  of  social  case  analysis,  the  case  of 
Greta  Meyer  seems  then,  comparatively  simple ;  namely,  a  case 
of  practically  pure  medical  disorder.  Not  even  the  economic 
factor  came  specially  into  evidence. 

Hours  spent  by  Medical  record,  22  pages 

Social  record,  6  pages 
Physician,  14  Social  work: 

Visits,  0 
Psychologist,  o  Interviews  at  hospital,  5 

Telephone  calls,  i 
Social   worker,  3j/<  Letters,  2 


THE    KINGDOM    OF    EVILS  'lQ>'] 

Familial  syphilis.  Routine  examination  of  "wife  and  children: 
positive  blood  test  in  all.  No  other  indications  of  syphilis: 
source  of  infection  unknown. 

Case  41.  We  borrow  the  case  of  Walter  Heinmas  from 
the  medical,  legal,  and  social  part  of  the  Southard  and  Solomon 
book  on  Neurosyphilis,  (in  that  collection  case  97),  not  because 
either  he  or  his  family  ever  came  to  the  point  of  social  treat- 
ment, but  because  the  problem  of  familial  syphilis  seems  ex- 
quisitely exemplified  in  the  children.  The  situation  is  one 
which  rather  astounds  even  medical  men  who  are  not  al- 
ways too  well  aware  of  the  caprice  with  which  syphilis  shows 
itself. 

Heinmas  himself  was  a  case  of  general  paresis  of  a  classical 
type,  with  marked  feeling  of  well-being  (the  so-called  euphoria) 
and  characteristic  grandiosity. 

It  is  the  routine  procedure  of  the  Psychopathic  Hospital  to 
look  into  the  families  of  syphilitic  patients.  The  Heinmas 
family  consisted  of  the  parents  and  two  daughters  aged  nine 
and  seven  respectively.  Both  the  patient  himself  and  his  wife 
denied  all  knowledge  of  syphilitic  infection,  nor  was  the  wife 
able  to  support  the  idea  that  she  had  ever  had  any  primary, 
secondary,  or  tertiary  symptoms;  especially  there  had  been  no 
abortions,  miscarriages,  or  stillbirths.  Both  children  had 
been  born  at  term  and  had  been  absolutely  healthy.  Upon 
examination,  the  mother  had  no  physical  signs  which  could  be 
referred  to  syphilis.  Both  daughters  were  well  endowed  in 
mind,  were  of  very  good  physique  and  showed  no  stigmata  of 
congenital  syphilis,  yet  the  blood  tests  of  all  three  (the  mother 
and  two  children)  proved  positive.  These  tests  were  repeated 
several  times  with  the  children  (both  with  and  without  sal- 
varsan  injections)  and  their  bloods  remained  consistently 
positive. 

In  the  Southard  and  Solomon  series  it  has  been  found  that 
about  15  per  cent  of  the  marriages  wherein  one  spouse  develops 
paresis  result  in  sterility,  in  18  per  cent  there  are  abortions, 
miscarriages,  or  stillbirths,  in  15  per  cent  there  are  positive- 
Wassermann  reactions  in  one  or  other  members  of  the  family. 
The  rather  obvious  motto  can  be  adopted:  "The  families  of 
paretics  are  the  families  of  syphilitics." 


20h  THE    KINGDOM    OF    EVILS 

Hours  spent  by    ,  Medical   record,  2  pages 

Social  record,  i  page 
Physician,  3^^  Social  work: 

Visits,  5 
Psychologist,  o  Interviews  at  hospital,  3 

.  Telephone  calls,  13 

Social  worker,  9  Letters,  19 


GENERAL  PARESIS 
IN  A  MACHINIST 


October,   ipi6 

Disabled  for  Work 

Inebriety 

Marital  Discord 

No  Income 

Debts 

No  Money  for  Therapy 


January,  ipi/ 
Employed 
Sobriety 
Happiness 
Adequate  Wages 
Debts  Reduced 
Treatment 


Paretic  machinist,  alcoholic,  neglected  treatment:  on  the  verge 
of  complete  breakdown.  Restored  in  three  months  to  industrial 
efficiency  through  combined  medical  and  social  treatment.  Pro- 
moted to  foreman. 

Case  42.  David  Collins  we  present  as  a  good  example  of 
social  problems  in  that  common  form  of  syphilitic  mental  dis- 
ease known  as  general  paresis. 

General  paresis  is  a  kind  of  mental  disease  long  known  by 
psychiatrists  and  has  always  been  thought  to  have  a  fatal  prog- 
nosis in  a  period  ranging  say  from  three  to  five  years  from  the 
onset  of  symptoms.  Patients  surviving  that  period  for  any 
considerable  length  of  time  would  ordinarily  be  regarded  as 
either  not  cases  of  general  paresis  at  all  or  very  non-typical 
ones.  Accordingly  the  psychiatrist  and  the  medical  man  in 
general  would  feel  very  skeptical  as  to  the  value  of  spending 
overmuch  time  or  money  upon  social  work  designed  to  bring 
out  earning  abilities  or  develop  valuable  changes  of  character  in 
victims  of  general  paresis.  No  doubt  this  skepticism  is  statis- 
tically rather  well  founded.  Yet  modern  work  seems  to  show 
that  neither  mental  and  nervous  symptoms  nor  laboratory  signs 
(blood  serum,  spinal  fluid,  etc.)  alone,  nor  any  combination  of 
these  symptoms  and  signs,  will  invariably  suffice  to  establish 
the  diagnosis  of  general  paresis  in  the  early  months  or,  let  us 
say,  in  the  first  year  of  its  symptoms. 

If  a  mental  disease  looking  like  general  paresis  is  not  going 
to  prove  to  be  general  paresis,  what  form  of  disease  is  likely 
to  develop?  There  is  another  form  of  syphilis  of  the  nervous 
system  ( for  which  the  abbreviated  term  neurosyphilis  has  come 
into  general  use)  called  cerebral  syphilis  or  cerebrospinal  syphi- 
lis or  diffuse  neurosyphilis,  which  form  has  a  much  more  favor- 
able prognosis  with  respect  to  duration  and  a  much  more  fav- 
orable prognosis  with  respect  to  the  self-supporting  capacity 
and  manageability  of  the  victim.  It  may  accordingly  make  a 
crucial  difference  to  the  man  and  his  family  whether  he  is  dis- 
govered  eventually  to  have  the  paretic  form  of  neurosyphilis 

2.U 


212  THE    KINGDOM    OF    EVILS 

(i.e.,  general  paresis)  or  the  diffuse  form  of  neurosyphilis 
(commonly  called  cerebrospinal  syphilis).  The  medical  man 
should  not,  and  the  medical  social  worker  cannot,  neglect  the 
other  members  of  the  paretic's  family.  The  children  of  a 
paretic,  are,  of  course,  the  children  of  a  syphilitic  (examples 
of  the  value  of  this  slogan  are  given  elsewhere  in  Section  I  of 
this  book)  and  accordingly  various  steps  in  mental  and  physical 
hygiene  must  be  taken.  These  latter  we  do  not  discuss  under 
the  case  of  David  Collins,  but  call  attention  rather  to  the  value 
of  psychiatric  social  work  for  the  family. 

Disabled  for  work  in  October,  1916,  David  Collins  had,  in 
three  months,  found  work  with  the  firm  that  had  previously 
employed  him.  From  a  condition  of  inebriety  he  had,  under 
the  social  service  influence,  become  sober.  A  state  of  serious 
marital  discord  had  been  replaced  with  domestic  happiness. 
The  family  which  had  had  no  income  in  October  had,  by  Jan- 
uary, the  advantage  of  adequate  wages.  The  debts  previously 
incurred  had  been  reduced,  and  treatment  for  the  man's  neuro- 
syphilis had  been  arranged  for.  The  case  had  been  an  appealing 
one  to  the  social  service,  and  it  proved  easy  to  raise  money 
by  newspaper  advertising  (under  "Divers  Good  Causes")  on 
the  ground  that  he  was  in  dire  need  of  medical  treatment  and 
would  otherwise  lose  his  mind.  It  must  also  be  noted  that 
within  the  first  three  months  of  social  work  the  wife  had  also 
gone  under  treatment  (blood  test  of  a  child  proved  negative). 

Collins,  at  forty-five,  had  had  to  give  up  his  machine  shop 
work  on  account  of  becoming  tremulous  and  sometimes  con- 
fused about  his  work.  He  fell  down  unconscious  a  number 
of  times.  When  he  arrived  at  the  Psychopathic  Hospital  out- 
patient department  with  his  wife,  they  had  nothing  but  return 
carfare  upon  them,  and  it  was  found  that  they  had  no  means 
of  income  whatever. 

Already  two  years  of  possible  treatment  had  been  lost,  since 
the  patient  had  two  years  before  been  brought  to  the  hospital 
by  the  police  who  had  found  him  in  convulsions  on  the  street. 
At  that  time  he  had  refused  to  return  for  treatment.  Such  a 
refusal  is,  of  course,  a  matter  of  great  regret  to  the  ardent 
believer  in  social  work  and  intensive  medical  treatment  for 
neurosyphilis.  No  doubt,  in  an  ideal  mental  hygiene  situation 
enough  force  and  ingenuity  could  be  brought  to  bear  to  bring 
all  such  cases,  even  when  like  Collins  exceedingly  recalcitrant, 


THE    KINGDOM    OF    EVILS  213 

under  medical  and  social  care.     He  had  always  been  a  hard 
drinker  and  was  still  drinking. 

It  seems  that  he  had  had  three  jobs  in  two  years  which  he 
had  been  forced  to  leave,  finding  each  one  too  hard  for  him. 
By  arrangement  with  the  social  service,  the  manufacturing 
firm  that  had  previously  employed  him  allowed  him  two  morn- 
ings ofif  a  week  to  come  for  his  treatment,  on  condition  that 
he  make  up  the  time  at  night.  On  this  basis  he  got  his  full 
pay,  twelve  dollars  a  week.  He  was  influenced  to  stop  drink- 
ing, the  wife  becoming  immediately  reconciled  with  him  again 
and  said  it  was  the  best  day  of  her  life  when  she  brought  him, 
two  years  after  his  first  hospital  appearance,  to  the  out-patient 
department.  Now,  she  said,  they  had  become  "like  sweethearts 
again."  Besides  obtaining  treatment  for  the  wife,  work  was 
found  for  her  by  the  social  service.  Ordinarily  it  vvould  be 
considered  rather  poor  social  work  to  cause  the  wife  to  go 
out  to  work  but  in  this  particular  situation  it  seemed  advisable, 
so  that  the  debts  of  the  family  might  be  paid  off.  Shortly  Col- 
lins himself  obtained  a  raise  of  pay.  Later  on  he  was  promoted 
to  the  position  of  foreman. 

In  some  ways  this  case  of  Collins  might  seem  a  schematically 
simple  one.  We  find  in  our  notes,  however,  that  the  investiga- 
tion entailed  inquiries  of  (i)  Mrs.  Collins,  (2)  the  priest,  (3) 
previous  employers,  (4)  neighborhood  storekeeper,  (5)  daugh- 
ter's teacher,  (6)  the  landlord,  (7)  previous  landlady,  (8)  a 
neighbor,  (9)  the  social  service  of  a  hospital  where  Collins 
had  once  been  treated.  Valuable  data  were  obtained  from  prac- 
tically all  of  these  sources.  It  is  plain  that  without  a  consider- 
able social  service  staff  this  kind  of  work  cannot  be  done  and 
that  it  is  entirely  out  of  the  question  to  suppose  that  the  admin- 
istrative officer,  whether  medical  or  social,  who  sits  at  his  desk 
in  however  well  appointed  an  institution,  can  obtain  these  data 
in  such  quantity  as  to  permit  valuable  work. 

Let  us  remark,  too,  in  passing,  upon  the  tremendous  change 
in  the  attitude  of  public  and  private  charitable  institutions 
toward  such  problems  as  these.  Time  was  when  each  institu- 
tion "passed  the  buck"  to  some  other  institution  and  hardly 
any  board  of  trustees  would  advocate  "borrowing  trouble"  by 
seeking  cases  to  treat  in  the  community.  Yet  we  believe  we 
are  safe  in  asserting  that  this  modern  attitude  toward  the  hid- 
den sources  of  disease  in  the  community  is  the  only  attitude 


214  THE    KINGDOM    OF    EVILS 

which,  in  the  long  run,  turns  the  trick  of  eradicathig  either 
venereal  disease  or  any  other  form  of  widespread  social 
disease. 

Yet  with  all  the  rather  optimistic  features  present  in  the 
early  progress  of  Collins'  social  care,  under  pressure  of  work 
the  case  was  too  early  closed  and  not  followed  up  as  it  might 
and  should  have  been.  It  was  again  reopened  through  the 
vigilance  of  officers  having  in  mind  the  tremendous  value  of 
this  program  of  social  work  in  neurosyphilis,  and  Collins  went 
again  under  treatment.  He  was  particularly  difficult  on  ac- 
count of  his  alcoholic  tendencies  and  on  account  of  the  usual 
story  on  the  part  of  these  patients,  namely  their  tendency,  as 
soon  as  they  feel  rather  well  again,  to  drop  treatment  and  re- 
fuse to  report.  This  is  the  story  not  alone  in  the  social  care 
of  neurosyphilis  but  in  that  of  many  other  forms  of  chronic 
disease.  All  in  all,  Collins  received  regular  treatment  by  sal- 
varsan  for  a  continuous  period  of  nineteen  months  and  subse- 
quently for  further  periods.  He  is  one  of  the  cases  under 
systematic  therapeutic  investigation  by  the  Massachusetts  Com- 
mission on  Mental  Diseases.  What  is  to  be  the  outcome  of 
that  investigation  which  began  in  19 14  and  has  under  observa- 
tion several  hundred  neurosyphilitics  can  doubtless  not  be  said 
until  the  period  of  a  decade  has  elapsed. 

Here,  then,  is  a  sample  of  mental  disease  clearly  syphilitic 
in  origin,  clearly  chronic  in  its  course,  if  not  likely  to  pass 
rapidly  into  dementia  and  death;  yet  by  combined  efforts  of 
the  medical  and  social  service,  a  reasonably  good  front  to  the 
disease  on  the  one  hand  and  the  world  on  the  other  was  pro- 
vided. We  now  have  a  history  of  five  years  since  his  first 
appearance  in  the  hospital  after  falling  into  convulsions  on 
the  street,  and  we  have  a  history  of  three  years  since  the  initia- 
tion of  a  period  of  regular  treatment.  Whatever  be  the  patho- 
logical fate  of  David  Collins,  whether  it  be  early  or  late,  at  all 
events  partial  or  temporary  cure  by  social  service  must  be  scored 
for  the  Collins  family,  as  well  as  for  its  central  psychopathic 
figure.  His  case  is  by  no  means  an  isolated  one  in  our  experi- 
ence. We  feel  ourselves  entitled  to  crave  most  earnestly  the 
concession  by  medical  men  that  social  service  energy  shall  be 
duly  expended  even  upon  these  cases  of  such  (statistically 
founded)  unfavorable  prognosis.  It  is,  perhaps,  also  worth 
while  to  insist  that  neither  the  intensive  medical  care  nor  the 


THE    KINGDOM    OF    EVILS  215 

elaborate  social  care  undertaken  in  the  case  of  David  Collins 
would  have  been  vv^arrantable  by  itself  alone. 

Hours  spent  by  Medical  record,  11  pages 

Social  record,  26  pages 
Physician,  8  Social  work  : 

Visits,  2."] 
Psychologist,  o  Interviews  at  hospital,  15 

Telephone  calls,  5 
Social  worker,  51  Letters,  9 


General  paresis  in  a  soldier;  at  first  thought  to  be  dementia 
praecox. 

Case  43.  Carl  Spindler  came  from  a  public  health  hos- 
pital with  the  diagnosis  of  dementia  praecox.  His  case  was 
found  to  be  one  of  general  paresis  requiring  commitment.  He 
was  incoherent,  and  very  talkative,  to  the  efifect  that  he  was 
going  to  Washington  to  take  the  President's  place,  that  the 
girls  were  all  crazy  about  him,  and  that  he  had  plenty  of  money. 
He  was  a  well-built  man  of  thirty-three  of  German  descent. 
He  had  worked  in  packing  houses  until  he  enlisted  in  the  army. 
He  had  seen  service  in  France,  where  he  had  got  a  number 
of  shrapnel  wounds  and  had  been  gassed.  He  was  transferred 
to  a  state  hospital  for  prolonged  care. 

Hours  spent  by  Medical  record,  7  pages 

Social   record,    i   page 
Physician,  314  Social  work  : 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  2 

Telephone  calls,  o 
Social  worker,  lYz  Letters,  2 


Steady  young  soldier  who  began  to  sing,  dance,  and  fight. 
Taboparesis.     Symptoms  following  his  mother's  death. 

Case  44.  Thomas  Scannell  was  drafted  at  the  age  of 
twenty-one  and  had  been  in  the  army  fifteen  months  (of  which 
seven  months'  service  in  France)  before  he  was  sent  to  an 
A.  E.  F.  hospital.  He  passed  through  three  hospitals  in  this 
country  where  he  was  thought  in  turn  to  be  suffering  from  (a) 


2l6  THE    KINGDOM    OF    EVILS 

dementia  praecox,  (b)  general  paresis,  and  (c)  manic-depres- 
sive psychosis.  He  was  excited  and  talkative  (threatening, 
e.g.,  to  write  to  the  President  for  a  better  room),  sang,  danced, 
and  fought.  In  the  Psychopathic  Hospital  he  proved  definitely 
a  paretic  (taboparetic  form).  Accordingly  commitment  was 
recommended.  But  his  sister  and  her  husband,  both  plainly  of 
low  mentality,  insisted  upon  taking  him  home,  saying  that  they 
should  never  feel  satisfied  if  he  were  not  given  a  chance  at 
home.  He  is  now  receiving  treatment  as  an  out-patient  only. 
His  mother  died  while  he  was  in  France,  and  he  himself  at- 
tributes his  illness  to  nervousness  resulting  from  worry  over 
her  death. 

He  is  the  illegitimate  child  of  a  hard-working  respectable 
woman  married  to  a  worthy  man  who  died  when  the  boy  was 
eight  years  old.  Scannell  was  a  steady  young  man  with  a  pleas- 
ant disposition.  He  "was  crazy  about  his  sister's  baby."  He 
did  not  use  alcohol  and  had  held  one  job  for  five  years. 

Hours  spent  by  Medical  record,  lO  pages 

Social  record,  2  pages 
Physician,  2%  Social  work : 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  6 
Social  worker,  31/2  Letters,  6 


Boy  with  congenital  syphilis  (juvenile  tabes).  Dropped 
behind  in  school  at  eleven.  Difficulty  of  getting  parents  to  have 
treatment  for  him. 

Case  45.  The  physician's  point  in  presenting  Archibald 
Sherry,  the  twelve-year-old  victim  of  congenital  locomotor 
ataxia  (juvenile  tabes)  would  be  to  show  special  pride  in  his 
therapeutic  results  in  a  rare  disease.  The  case  has  been  pre- 
sented briefly  from  the  medical  point  of  view  as  case  38  in 
Southard  and  Solomon's  case  history  collection  Neurosyphilis. 
We  may  here  omit  the  medical  details.  The  layman  would, 
of  course,  readily  observe  the  unsteadiness  of  the  boy's  gait, 
and  would  come  upon  certain  oddities  in  his  teeth  (typical 
Hutchinsonian  teeth).  The  psychiatric  social  worker,  like 
other  lay  observers,  should  bring  notes  concerning  superficial 


THE    KINGDOM    OF   EVILS  21/ 

oddities  of  teeth  for  the  physician's  consideration  and  now 
and  again  the  worker  will  be  able  to  throw  considerable  light 
upon  obscure  cases  under  direct  medical  observation  by  retriev- 
ing sundry  dental  facts  concerning  relatives  of  the  patient, 
superficially  examined  in  the  course  of  taking  histories  in  the 
patient's  home. 

The  Sherry  boy,  after  the  diagnosis  of  his  syphilis  had  been 
thoroughly  proved  in  hospital,  was  treated  and  certain  pains 
of  his,  certain  attacks  of  confusion,  and  trouble  with  his  speech 
disappeared  upon  salvarsan  injections,  and  his  gait  became 
steadier. 

From  the  standpoint  of  social  psychiatry,  Sherry's  family 
history  was  of  interest.  On  the  father's  side  there  was  nerv- 
ousness (as  well  as  alcoholism  and  degeneracy).  The  number 
of  things  which  "nervousness"  may  at  bottom  be  is  legion;  of 
course  no  conclusion  as  to  syphilis  in  the  family  could  be  drawn 
either  from  a  history  of  nervousness  or  of  degeneracy.  The 
fact  that  the  maternal  grandmother  had  cancer  is,  no  doubt,  of 
no  importance.  A  sister,  four  years  older  than  Archibald,  was 
also  thought  to  be  "nervous"  and  unstable.  One  task  of  social 
psychiatry  was  to  have  this  girl  examined  for  syphilis  and 
especially  to  have  her  blood  and  spinal  fluid  examined.  Both 
blood  and  spinal  fluid  failed  to  yield  signs  of  syphilis. 

Instructive  also  is  the  fact  that  Archibald,  although  always 
a  weak  and  sickly  child,  did  well  in  school  to  the  end  of  his 
eleventh  year,  when  his  capacity  to  keep  up  with  the  other  chil- 
dren dropped  and  he  became  no  longer  so  amiable  and  sociable. 
An  odd  thing  in  the  case  was  that  the  eye-lashes  of  the  boy  had 
turned  white  during  the  year. 

It  was,  of  course,  also  the  duty  of  the  social  service  to  se- 
cure blood  reactions  of  father  and  mother,  who  denied  syphilis. 
The  reactions  of  both  father  and  mother  proved,  in  fact,  nega- 
tive, and  also,  as  above  noted,  that  of  the  older  sister.  The 
medical  observers  remained  in  doubt  as  to  whether  the  case 
was  one  of  syphilitic  disease  handed  down  from  father  or 
mother,  or  whether  the  case  was  one  of  a  rare  or  unique  con- 
dition, namely — "acquired"  juvenile  tabes.  (Concerning  the 
true  meanings  of  the  terms  hereditary,  congenital,  and  ac- 
quired, the  psychiatric  social  worker  should  make  absolutely 
sure.) 

Social  work  in  this  case  proved  difficult  by  reason  of  lack  of 


2l8 


THE    KINGDOM    OF   EVILS 


cooperation  on  the  part  of  Archibald's  mother.  Treatment 
could  not,  in  fact,  be  consistently  continued.  However,  social 
workers  from  time  to  time  visited  the  boy  in  his  home,  and  he 
has  apparently  shown  no  setback  since  his  initial  improvement 
following  a  few  injections  of  salvarsan  into  the  blood  that  were 
made  some  six  years  ago. 


Hours  spent  by 
Physician,  5^/3 
Psychologist,  o 
Social  worker,  4254 


Medical  record,  9  pages 
Social  record,  18  pages 
Social  work : 

Visits,  24 

Interviews  at  hospital,  3 

Telephone  calls,  18 

Letters,  14 


Industrial  disability  caused  by  syphilis.     Under  treatment 
returned  to  work. 


Case  46.     The  full  text  of  Harold  Gordon's  social  record 
is  given  in  Appendix  A. 


SECTION  II 

HYPOPHRENOSES    ( FEEBLE-MINDEDNESS) 

High-grade  moron,  daughter  of  a  good  family.  Stealing, 
sex  irregularity.  "Football  of  environment."  Institutional 
care.    Need  of  psychiatrist,  psychologist,  and  social  worker. 

Case  47.  Florence  Warner,  nineteen,  brought  to  the 
Psychopathic  Hospital  for  observation  at  the  family  physi- 
cian's suggestion,  turned  out  to  be  a  moron,  measuring  11.5 
years  by  the  Point  Scale  and  10  1/5  years  by  the  Binet  Scale. 

It  is  worth  while  to  premise  that  these  minor  differences  in. 
the  mental  test  levels,  as  is  clear  from  the  data  of  many  previous 
cases  in  this  book,  allow  no  doubt  whatever  that  the  girl  so 
tested  was  a  moron, — provided  always  that  the  tests  were  car- 
ried on  under  favorable  conditions  without  (a)  fatigue  on 
the  part  of  the  examiner,  or  (&)  on  the  part  of  the  patient, 
without  (c)  any  clouding  of  consciousness,  such  as  infectious 
disease,  alcohol,  drugs  or  other  condition  might  produce  and 
{d)  without  any  trace  of  stupor  or  dullness  of  mental  facul- 
ties incident  to  many  forms  of  the  frank  psychoses.  None  of 
these  latter  phenomena  were  shown  by  Florence  Warner.  She 
was  at  the  time  of  examination  perfectly  clear-headed  and 
capable  of  a  very  fair  amount  of  attention  to  the  tests.  In  fact 
we  find  from  the  report  recorded  that  her  comprehension  was 
good  and  that  she  had  a  very  excellent  power  of  reasoning  in 
the  examples  set  for  her.  Her  memory,  to  be  sure,  was  only 
fair  and  her  anal3^ical  power  limited.  Her  loss  of  points  in 
the  mental  tests  accordingly  was  a  rather  general  one  and  the 
separate  items  were  valued  from  rather  poor  to  fairly  good  or 
even  good — being  for  the  most  part  only  fair. 

We  may  further  take  occasion  at  this  point  to  say  that  the 
detailed  procedures  of  the  mental  tests,  whether  by  the  various 
revisions  of  Binet  or  by  the  Point  Scale,  are  entirely  within  the 
scope  of  a  social  worker  to  learn  and  even  to  use,  as  (in  point 
of  fact)  these  procedures  are  within  the  scope  of  any  well  edu- 

219 


220  THE    KINGDOM    OF    EVILS 

cated  person.  But  we  do  not  need  to  exhibit  the  prejudices  of 
an  overspecializing  psychologist  when  we  insist  that  these  tests 
are  not  to  be  trifled  with,  and  are  not  to  be  valued  highly  save 
when  performed  by  an  examiner  of  considerable  skill  and  ex- 
perience who  "has  his  hand  in"  and  who  for  the  most  part  is 
doing  little  else  in  life.  This  is  not  to  say  that  what  Professor 
James  called  the  Ph.D.  octopus  need  dominate  the  field  of 
practical  mental  examination,  although  for  our  part  we  feel 
that  every  laboratory  executing  routine  tests  in  important  cases 
should  be  managed  by  an  expert  psychologist  who  shall  stand 
sponsor  for  the  results.  Those  not  familiar  with  the  situation 
in  applied  psychology  may  not  bear  in  mind  how  rapidly  the 
field  is  changing  and  how  numerous  the  modifications  and  im- 
provements in  psychometric  tests  will  be  before  at  last  we  reach 
the  ideal  set  of  tests.  On  the  other  hand,  the  time  is  past  when 
anyone  can  safely  doubt  the  present-day  value  of  the  tests  we 
have  within  ordinary  limits  of  variation  and  under  the  special 
safe-guarding  conditions  enumerated  above. 

The  problem  in  the  Warner  case  was  stealing  and  sex  irregu- 
larity. While  we  are  discussing  the  psychometric  tests  it  may 
be  worth  while  to  insist  that  these  tests  throw  little  or  no  light 
upon  the  causes  of  such  bad  habits  or  vices.  The  mental  tests, 
being  almost  exclusively  intcUigcnce  tests,  throw  little  light 
upon  either  the  quality  or  the  level  of  the  emotional  or  voli- 
tional sides  of  the  person  examined.  To  be  sure  Florence  War- 
ner was  somewhat  "suggestible"  to  test;  but  this  "suggesti- 
bility" is  a  very  specific  one  which  does  not  necessarily  argue 
that  the  one  who  shows  it  steals  or  enters  into  irregular  sex 
relations  on  account  of  it.  Tlie  chances  are  that  Florence  was 
the  "football  of  environment" ;  but  it  would  require  a  far  more 
elaborate  analysis  by  psychiatrists  (or  by  persons  otherwise 
expert  in  the  world's  ways)  to  prove  that'  her  irregularities 
were  phenomena  of  weak  will  or  suggestibility.  How,  we  may 
ask,  shall  such  analysis  of  all  sides  of  the  mentality  be  made 
as  will  throw  the  needed  light  upon  the  causes  of  stealing,  sex 
irregularity,  and  the  like?  There  is  no  certain  answer  to  this 
question,  although  various  psychiatrists  and  psychologists  have 
suggested  schemata  for  analyzing  personality  under  various 
headings. 

It  seems  that  Florence  had  been  in  the  habit  of  stealing  from 
members  of  her  family  and  from  friends  ever  since  she  wa.s  vj 


THE    KINGDOM    OF    EVILS  221 

small  child.  She  could  now  no  longer  live  in  her  brother's 
family  unless  means  were  found  by  which  she  could  support 
herself.  But,  as  she  was  given  to  stealing,  she  could  not  be 
recommended  to  any  employers.  To  add  to  the  difficulty  she 
had  recently  begun  sex  relations  with  various  men.  It  seems 
she  had  gone  to  a  distant  state  to  work  as  a  telephone  operator 
and  had  there  fallen  into  bad  habits — drinking,  smoking,  and 
irregular  sex  living. 

Upon  the  discovery  of  her  level  as  a  high-grade  moron,  in- 
stitutional care  was  recommended,  on  the  particular  grounds 
that  she  was  a  high-grade  moron  of  such  a  trend  that  she  might 
benefit  by  institutional  care  and  would  otherwise  be  in  consider- 
able danger  of  becoming  a  source  of  venereal  infection.  In 
point  of  fact  Florence  was  still  negative  to  test  as  to  venereal 
disease,  but  was  already  being  strongly  urged  by  a  girl  friend 
to  join  the  prostitute  group. 

As  is  the  situation  in  most  of  our  states  in  the  present  phase 
of  mental  hygiene,  the  waiting  lists  at  the  schools  for  feeble- 
minded were  extremely  long.  However,  upon  the  Psycho- 
pathic Hospital's  representation,  Florence  was  listed  amongst 
the  urgent  cases.  She  was  in  the  meantime  sent  to  a  small  pri- 
vate institution  which  agreed  to  make  exception  to  its  general 
rule  not  to  receive  mental  cases.  The  institution  must  have 
regretted  its  step  at  the  end  of  three  months  since  Florence 
had  plotted  to  escape  with  another  girl  and  had  a  bad  influence 
on  the  other  girls. 

The  feeble-minded  schools'  waiting  lists  were  still  long  and 
in  the  interval  Florence  was  sent  to  the  state  infirmary,  i.e., 
the  big  almshouse  hospital  of  Massachusetts.  She  promptly 
took  a  violent  dislike  to  the  women  she  was  there  thrown  with 
and  was  given  night  work  so  that  she  might  avoid  them.  After 
three  almshouse  months  she  was  eventually  admitted  to  a  state 
school  for  feeble-minded.  She  immediately  began  to  mingle 
with  the  older  girls  and  seemed  to  become  perhaps  more  happy 
than  could  be  reasonably  expected. 

It  may  be  remarked  that  Florence's  family  was  on  rather  a 
high  level.  It  was  naturally  rather  hard  to  persuade  her  rela- 
tives to  let  her  go  to  a  state  institution.  Of  course  the  general 
level  of  mental  hygiene  in  Massachusetts,  as  in  a  few  other 
states,  is  such  that  we  may  hope  that  the  general  prejudices 
against  all  state  institutions  will  at  last  melt  away. 


222  THE    KINGDOM    OF    EVILS 

Could  such  a  case  be  handled  by  the  social  worker  in  com- 
bination with  a  competent  psychiatrist  ■mithout  the  aid  of  a 
psychologist f  The  psychiatric  examination  determined  her  to 
be  not  insane.  The  positive  evidence  for  the  moronity  in  Flor- 
ence is  derived  almost  wholly  from  the  mental  tests.  The  phys- 
ical examination  was  largely  negative;  still  it  may  be  of  some 
importance  to  the  girl  that  diseased  tonsils  and  a  functional 
heart  murmur  were  found.  The  medical  examination  also  was 
of  value  to  her  in  showing  that  she  was  not  as  yet  a  "venereal" 
case.  It  is  especially  important  to  her  that  the  psychiatrist 
could  find  no  evidence  of  a  definite  acquired  psychosis.  We 
feel  that  it  is  of  the  greatest  importance  to  exclude  psychosis 
from  these  cases  of  feeble-mindedness.  We  are  familiar  with 
numerous  cases  in  which  moronity  has  been  confused  with  ac- 
quired and  progressive  psychosis.  In  short,  we  hold  that  the 
psychiatric  examination  in  these  cases  has  extraordinary  nega- 
tive values. 

While  we  are  comparing  the  practical  values  of  the  psycholo- 
gist whose  data  made  the  positive  diagnosis  "moronity"  and 
of  the  psychiatrist  whose  examination  was  exclusive  of  any 
such  disease  as  dementia  praecox,  let  us  inquire  whether  the 
psychiatrist  and  the  psychologist  combined  could  have  handled 
this  case  effectively,  without  a  social  worker.  It  will  be  noted 
that  the  eventual  success  in  getting  Florence  into  the  right  in- 
stitution was  a  matter  of  very  time-consuming  and  ingenious 
persuasive  work.  The  more  competent  the  psychologist  the 
more  valuable  his  work  in  the  laboratory  and  the  less  likely 
he  or  she  would  be  inclined  to  "hug  the  telephone"  and  do  the 
traveling  necessary.  The  same  holds  for  the  psychiatrists. 
Moreover,  as  those  acquainted  with  social  service  technique 
are  well  aware,  neither  the  psychologist  nor  the  psychiatrist 
has  a  knowledge  of  the  institutional  equivalents,  institutional 
and  other  personalities,  community  and  neighborhood  habits 
and  peculiarities,  and  the  technical  facts  which  training  and 
experience  give  to  the  social  worker.  Happily  we  are  able  to 
say  that,  as  the  years  pass,  the  psychiatrists  and  psychologists 
are  becoming  less  willing  to  say  that,  just  because  they  under- 
stand every  social  service  device  employed,  therefore  they  can 
perform  the  steps  effectively  in  proper  sequence  and  without 
loss  of  time. 

With  respect  to  the  relations  of  the  general  medical  social 


THE    KINGDOM    OF    EVILS  223 

worker  to  the  general  problem  of  medicine,  there  is  no  longer 
any  doubt  of  the  necessity  of  a  medical  social  worker  in  any 
community  with  high  health  standards.  But  if  this  is  true  for 
general  medicine  and  the  medical  social  worker  in  general,  it  is 
one-hundred  fold  truer  still  for  the  complicated  relations  of 
the  psychiatric  social  worker.  In  fact  we  do  not  need  to  argue 
upon  this  line  for  those  who  have  had  any  practical  experience 
in  the  field.  But  we  take  occasion  in  discussing  this  first  of 
our  group  of  feeble-minded  cases  to  insist  upon  a  point  which 
stands  out  most  clearly  in  a  case  like  that  of  Florence  Warner. 
Of  course  we  do  not  know  what  the  eventual  outcome  in 
Florence  Warner's  case  may  be,  granted  that  the  psychometric 
diagnosis  of  feeble-mindedness  is  correct  (and  there  seems  to 
be  no  doubt  of  the  accuracy  of  the  diagnosis  in  this  case).  Pos- 
sibly it  will  be  in  some  respects  easier  to  handle  a  moron  who 
steals  and  has  sex  irregularity  than  to  handle  a  person  of  per- 
fectly normal  mentality  with  precisely  the  same  trends;  but 
there  is  no  general  rule  to  this  effect. 

Hours  spent  by  Medical  record,  i8  pages 

Social  record,  5  pages 
Physician,  3^  Social  work  : 

Visits,  2 
Psychologist,  I  Interviews  at  hospital,  2 

Telephone  calls,  4 
Social  worker,  7  Letters,  4 


A  psychopathic  family.  Each  member  (parents  and  eight 
children)  an  indimdual  problem.  Syphilitic,  feeble-minded 
father.     Distinction  between  hereditary  and  congenital. 

Case  48.  The  family  is  today,  in  many  social  service  quar- 
ters, the  unit  of  interest  in  social  work.  We  do  not  deny  that 
the  family  ought  to  be  the  object  of  social  work,  yet  we  feel 
that  the  psychiatric  viewpoint  has  gone  far  to  prove  that  every 
family  should  be  analyzed  in  the  first  instance,  not  so  much 
from  any  supposed  general  family  tendency,  and  not  so  much 
from  the  standpoint  of  the  family  income  as  from  that  of  the 
social  situation  presented  by  each  member  of  the  family  taken 
as  an  individual.  We  are  aware  that  many  social  workers  will 
feel  that  this  plan  is  carrying  individualization  to  an  absurd 
degree.    Particularly  in  the  case  of  the  Newman  family,  whose 


224  THE    KINGDOM    OF    EVILS 

plight  we  hang-  upon  the  individual  case  of  Bessie,  but  which 
contained  ten  members  (parents  and  eight  children),  it  would 
seem  a  little  preposterous  to  consider  technically  every  member. 
But  let  us  consider  the  situation  of  each  member. 

Bessie,  the  third  child,  nineteen  years  of  age  as  we  now 
write,  is  a  case  of  feeble-mindedness  belonging  in  the  moron 
group,  measuring  psychometrically  94/12  years  by  the  Stan- 
ford-Binet  method  and  9.7  by  the  Point  Scale.  Bessie  whom 
we  first  observed  at  the  age  of  fifteen  was  at  once  determined 
to  be  suitable  for  a  state  school  for  the  feeble-minded.  The 
waiting  lists  were  too  long,  however,  and  she  could  not  be 
admitted.  She  remained  at  home,  finally  became  pregnant, 
altered  her  character  somewhat  thereafter  so  that  she  became 
something  of  a  runaway  and  was  delivered  of  a  child  which 
became  a  public  charge  (because  of  Bessie's  obvious  inability 
to  take  care  of  it  and  because  the  family  otherwise  had  already 
too  much  on  its  hands).  Bessie  remains  at  home  a  good  deal 
of  a  problem.  There  was  at  one  time  a  question  whether 
Bessie  might  not  be  a  victim  of  schizophrenia  (dementia 
praecox)  partly  on  account  of  the  history  of  her  going  over 
to  New  York  to  visit  a  prostitute  girl  friend  and  an  episode 
of  throwing  clothes  out  of  the  window.  Technically,  however, 
on  the  whole  no  convincing  proof  of  schizophrenia  could  be 
found.  In  any  event  such  a  process  would  have  been  one 
grafted   upon   an   original    feeble-mindedness. 

It  was  not  Bessie,  but  a  sister  Rachel,  seven  years  younger, 
who  first  came  to  the  hospital's  attention.  She  was  sent  by 
her  teacher  for  falling  out  of  her  chair,  one  day  as  often  as 
three  times  in  an  hour.  Rachel  was  found  to  grade  approxi- 
mately at  her  age  (eight)  at  the  time  of  examination,  although 
there  was  the  hint  of  subnormality  in  her  comprehension, 
emotional  control,  and  power  of  concentration.  No  definite 
psychosis  was  determined  for  Rachel ;  but  a  certain  hyper- 
kinetic tendency  on  her  part  might  look  in  the  direction  of 
some  form  of  psychopathic  personality. 

She  came  under  hospital  observation  two  years  later,  a 
nail-biter  and  thumb-sucker,  still  suffering  from  the  hyper- 
kinetic tendency  which  was  termed  "nervousness"  and  "insta- 
bility." Under  hospital  observation,  as  is  so  frequent,  the 
girl  showed  no  sign  of  the  hyperkinesis  noted  outside  but 
when  she  returned  home  she  was  as  bad  as  ever. 


THE    KINGDOM    OF    EVILS  225 

The  most  important  individual  problem  next  in  order 
amongst  the  children  is  that  of  Isaac,  the  oldest  son,  now 
twenty-three.  He  is  definitely  feeble-minded,  grading  9.7 
years  by  Point  Scale  when  observed  at  the  age  of  eighteen 
and  a  half.  Icaac's  record  shows  a  general  leveling  down  of 
his  mental  capacities  although  his  power  of  attention  and  his 
emotional  control  are  more  prominently  affected  than  the  other 
faculties  (recalling  the  situation  with  Rachel).  Isaac  was 
unable  to  read  or  write  but  made  five  dollars  a  week.  He 
was  a  domestic  nuisance  because  he,  without  provocation,  ad- 
ministered heavy  blows  to  the  children.  At  the  present  time 
he  is  working  with  fair  regularity  for  a  relative  and  gives  no 
trouble,  though  he  "knows  it  all."  He  often  sits  for  long 
periods  without  talking  and  cannot  eat  if  the  other  children 
are  about. 

His  next  younger  sister,  Molly,  two  years  older  than  the 
third  child  Bessie,  seems  to  be  absolutely  normal  in  every 
respect,  is  physically  something  of  an  athlete,  and  was  found 
upon  the  Psychopathic  Hospital  observation  to  be  normal  in- 
tellectually. Were  it  not  for  the  abnormality  of  all  the  other 
members  of  this  family  of  ten,  we  should  regard  Molly's 
having  an  illegitimate  child  as  not  especially  suggestive  of 
psychopathy.  Perhaps  it  is  safer  not  to  guess  psychopathy 
even  against  the  heavy  atmosphere  of  the  Newman  family. 
Molly  has  also  a  so-called  "doubtful"  Wassermann  serum  reac- 
tion of  the  blood  which  so  often  turns  positive  later  on  and 
is  always  suspicious.  (The  father  of  the  family  was  syphilitic 
to  test.)  Molly,  with  the  aid  of  one  of  the  children's  agencies, 
made  some  effort  to  take  care  of  her  child  but  eventually  had 
it  placed  for  adoption.  She  later  made  what  seemed  to  be 
a  promising  marriage.  When  her  husband  returned  from 
army  service,  he  failed  to  support  her  and  became  sexually 
abusive.  Now  she  is  back  with  her  own  family  seeking  a 
divorce.  She  claims  that  one  of  the  reasons  for  her  quarrels 
with  her  husband  is  his  failure  to  keep  the  agreement  he  made 
when  they  married  that  he  would  take  steps  to  find  and  recover 
her  first  child. 

Having  considered,  first  Isaac,  second  Molly,  third  Bessie, 
we  come  now  to  the  fourth,  Louis,  two  years  younger  than 
Bessie  and  five  years  older  than  Rachel.  He  tested,  when 
his  actual  age  was  thirteen,  ten  years  by  the  Binet  and  11. 3 


226  THE    KINGDOM    OF    EVILS 

by  the  Point  Scale.  He  was  a  boy  with  an  uncontrollable 
temper  and  hyperkinetic  in  various  ways,  making  grimaces  and 
jerky  movements  of  the  limbs.  He  is  now  in  a  special  class 
at  a  business  school  but  is  doing  very  unsatisfactory  work  and 
will  no  doubt  shortly  drop  out. 

Daniel  two  years  younger  than  Louis,  is  bright  in  school, 
a  nervous,  irritable  boy  with  a  positive  Wassermann  serum 
test.  He  seemed  to  be  always  in  a  fight.  His  brother,  two 
years  older  (Louis)  and  his  father  were  especial  irritants  for 
him.  He  was  quite  uncontrollable  by  his  mother.  This  boy 
Daniel  graded  a  few  points  higher  than  his  actual  age,  eleven 
and  a  half,  by  both  the  Point  Scale  (11.8)  and  the  Binet 
(11  3/5 ) .  He  may  be  regarded  as  in  a  general  way  somewhat 
precocious  and  to  test  was  deficient  only  in  his  learning  ability 
and  in  a  certain  oversuggestibility. 

Of  the  two  remaining  children,  Leo,  now  eleven,  is  a  good 
deal  of  a  problem.  He  is  also,  like  his  brother  Daniel,  not 
feeble-minded.  He  is  a  restless,  quarrelsome,  and  excitable 
boy  who  cannot  sit  still  and  (resembling  Rachel's  falling  from 
her  chair  at  school)  often  falls  down  when  playing  or  walking. 
He  has  recently  developed  hysteria  and  has  already  had  two 
sufficiently  pronounced  attacks  with  paralysis  of  a  leg.  This 
paralysis  combined  with  pain  in  the  back  of  the  knee  has  at 
times  been  cured  for  the  moment  through  persuasion  and 
command  by  the  psychiatrist. 

Sally,  now  seven  years  of  age  and  the  youngest,  was  at 
three  years  regarded  as  a  bright  little  girl  and  passed  most  of 
the  four-year-old  tests.  She  even  now  grades  approximately 
to  her  actual  age.  She  cries  continually,  has  a  violent  temper, 
is  given  to  biting  herself  when  angry,  hits  herself  against  the 
wall  and,  like  Leo  and  Rachel,  has  the  falling  tendency  noted 
for  them. 

What  kind  of  parents  did  these  eight  children  possess?  The 
father  Jacob,  examined  at  forty-four,  proved  to  have  a  mental 
age  of  some  9  years.  His  blood  serum  showed  a  suggestively 
positive  reaction  for  syphilis  (three  years  later  a  test  proved 
definitely  positive).  At  the  earlier  age  it  was  thought  that 
some  organic  mental  disease,  presumably  a  form  of  neuro- 
syphilis, was  developing.  Jacob  makes  many  complaints  at 
home,  grows  easily  angry  but  has  not  in  three  years  of  obser- 
vation yet  developed  any  progressive  mental  disease.     What- 


THE    KINGDOM    OF    EVILS  2.2^ 

ever  he  may  develop,  it  seems  likely  that  he  is  feeble-minded. 
It  might  be  inquired  whether  Jacob  acquired  his  syphilis  or 
was  perhaps  the  victim  of  congenital  syphilis.  He  has  no 
marked  stigmata  to  external  observation.  There  is  appar- 
ently some  enlargement  of  the  right  lobe  of  the  thyroid.  A 
heart  examination  taken  in  connection  with  the  positive  serum 
test  suggests  aortic  disease.  There  was  some  tendency  to 
clubbing  of  the  finger  nails  and  there  was  a  pronounced 
cyanosis  of  both  hands.  He  sometimes  complains  of  attacks, 
which  taken  into  association  with  his  syphilis,  might  seem  to 
suggest  organic  disease  of  the  nervous  system.  Yet  it  is  pos- 
sible that  many  of  these  phenomena  in  Jacob  are  hysterical. 

His  wife,  Sadie  Newman,  although  a  woman  of  somewhat 
limited  intelligence  (not  tested  but  almost  certainly  not  defec- 
tive; has  efficient  brothers  known  to  the  social  service)  has 
some  psychoneurotic  symptoms  (heat  flashes,  nervous  spells 
with  chin  quivering  and  inability  to  speak,  feeling  of  general 
weakness).  Almost  all  the  other  features  in  Sadie's  life  are 
extraordinarily  to  her  advantage.  She  has  naturally  had  a 
most  difficult  life  but  has  brought  the  afflicted  family  through 
more  difficulties  than  a  normal  mother  would  like  to  face. 
Mrs.  Newman  has  had  in  all  twelve  pregnancies.  The  first 
was  a  miscarriage  and  the  second  child  died  young  (thought 
to  be  feeble-minded).  Then  came  Isaac,  the  definitely  feeble- 
minded boy.  These  first  three  pregnancies  form  the  clinical 
ascending  scale  of  improvement  found  in  the  syphilitic  family 
and  the  fourth  child,  athletic  Molly,  might  be  regarded  as 
showing  that  the  syphilitic  taint  had  run  itself  out.  However, 
next  came  a  definitely  feeble-minded  child,  Bessie,  an  ugly, 
pugnacious  child.  After  Bessie  came  the  second  and  last 
miscarriage.  Then  came  the  grimacing,  high-tempered  Louis, 
followed  by  nervous  Daniel  with  his  positive  serum  test ;  then 
came  Rachel,  Leo,  and  Sally  with  their  overactivity  and  falling 
tendencies,  but  between  Leo  and  Sally  came  a  boy  that  died 
four  days  after  birth. 

We  spoke  of  Molly  as  possibly  terminating  the  syphilitic 
taint  shown  in  the  first  three  pregnancies  but  will  remind  the 
reader  that  this  good  child  (the  best  in  the  family)  herself 
had  a  doubtful  Wassermann  reaction  of  the  serum.  Three 
members  of  the  family,  Molly,  Daniel,  and  the  father  Jacob, 
have  suggestive  or  positive  Wassermann  serum  tests. 


228  THE    KINGDOM    OF    EVILS 

Of  course  if  we  should  construct  a  chart  of  the  mental  and 
nervous  diseases  and  defects  in  this  family  we  might  make 
out  a  strong  case  for  so-called  "heredity"  if  we,  for  the  mo- 
ment, forgot  the  syphilis  in  the  situation.  It  is  worth  while 
for  the  social  worker  to  remember  that,  after  all,  we  must 
regard  many  of  the  phenomena  in  this  family  as  preventable 
in  view  of  the  fact  that  most  of  these  phenomena  accord  very 
well  with  our  idea  of  what  syphilis  can  produce.  To  be  sure 
we  do  not  know  why  the  father  Jacob  was  feeble-minded  and 
it  may  be  that  the  expert  eugenist  could  trace  the  separate 
threads  of  inherited  feeble-minded  and  syphilitic  infection  in 
the  Newman  group.  We  do  not  at  all  know  that  the  father 
Jacob  was  a  congenital  syphilitic.  It  may  be  that  he  was  a 
feeble-minded  person  who  acquired  syphilis.  Furthermore  we 
must  point  out  a  number  of  psychoneurotic  traits  in  Mrs. 
Newman,  though  it  would  be  almost  fair  to  inquire  whether 
many  of  these  traits  were  not  a  rather  natural  acquisition  for 
a  housewife  in  her  plight.  At  all  events,  as  we  have  repeat- 
edly insisted  elsewhere  in  this  book,  the  social  worker  should 
not  confuse  the  hereditary  with  the  congenital.  What  the 
feeble-minded  part  of  Jacob  transmitted  may  perhaps  be  hered- 
itary. What  the  syphilitic  part  of  Jacob  contributed  was,  no 
doubt,  congenital.  We  would  not  bore  the  reader  to  under- 
stand the  distinction  between  hereditary  and  congenital  by  this 
repeated  insistence ;  however  we  have  heard  some  relatively 
expert  social  workers  on  the  platform  using  in  their  propa- 
ganda terms  which  signify  that  for  them  at  least  at  the  mo- 
ment, tJie  distinction  between  hereditary  and  congenital  did  not 
seem  to  be  a  worth-while  distinction.  It  will  be  observed  that 
this  distinction  is  a  very  important  one  psychologically  and  even 
from  the  standpoint  of  the  budget.  The  philanthropist  who 
wants  to  stop  hereditary  mental  disease  and  defect  may  per- 
haps best  proceed  by  endowing  eugenic  researches  and  propa- 
gandas. The  man  who  has  in  mind  the  prevention  of  certain 
preventable  forms  of  mental  disease  and  effect  (by  well-known 
public  health  methods,  now  being  rounded  into  marked  ef- 
ficiency) would  raise  money  on  the  venereal  disease  propa- 
ganda supported  by  research. 

Let  us  briefly  sum  up  the  social  treatment  of  the  Newman 
group :  I .  Financial  assistance  was  got  so  that  household  goods 
might  be  procured  with  which  more  decent  standards  could 


THE    KINGDOM    OF    EVILS  229 

be  maintained,  with  the  result  that  while  six  years  ago  the 
family  lived  in  dirty  and  dilapidated  surroundings  (there  was 
not  even  a  bed  for  one  of  the  sisters)  now  they  live  in  a  fairly 
well  appointed  apartment. 

2.  Numerous  and  changing  arrangements  had  to  be  made 
from  time  to  time  for  different  children.  Three  of  the  chil- 
dren have  been  boarded  out  for  periods  of  some  two  years 
each.  To  be  sure  these  children  were  neither  "dependent"  nor 
"neglected"  children  in  the  technical  sense  of  those  terms  so 
that  the  fact  that  a  public  agency  was  got  to  give  them  better 
care  must  be  scored  as  a  triumph  of  prevention. 

3.  Arrangements  had  to  be  made  for  two  confinements 
(illegitimacy  in  both),  and  for  the  care  of  the  illegitimate 
children. 

4.  The  father  had  to  be  instructed  concerning  work  and  his 
attitude  to  the  family. 

5.  Advice  and  encouragement  was  given  to  the  mother  in 
regard  to  the  father  and  in  regard  to  each  of  her  children  in 
turn. 

6.  The  relatives  had  to  be  advised  with  respect  to  the 
mental  condition  of  the  family  so  that  their  cooperation  might 
be  maintained.  It  was  natural  that  from  time  to  time  they 
should  lose  patience. 

It  may  be  noted  that  twenty-six  medical  and  social  agencies 
have  been  found  so  far  on  the  records  as  dealing  with  the  ten 
surviving  members  of  the  Newman  family. 

Hours  spent  by  Medical  record,  145  pages 

Social  record,  99  pages 
Physician,  491/^  Social  work: 

Visits,  95 
Psychologist,  15  Interviews  at  hospital,  38 

Telephone  calls,  105 
Social  worker,  180  Letters,  98 


Imbecile  boy  kept  at  work  by  frequent  changes.  Trained 
in  special  class.  Feeble-minded  father  gotten  a  job:  sick  mother 
treated. 

Case  49.  The  Rosenthal  family  pales  into  insignificance 
beside  the  Newman  family.  Yet  amongst  five  members  three 
are  definitely  psychopathic  up  to  date.     The  boy,  Nathan,  was 


236  THE    KINGDOM    OF    EVILS 

the  first  to  appear  under  hospital  observation.  He  was  sent 
by  a  school  teacher  with  a  question  as  to  his  mental  defect 
and  yielded  a  Binet  rating  of  6  with  an  actual  age  of  twelve 
years.  Once  later  he  tested  at  a  rather  lower  level  but  at  the 
last  examination  definitely  tested  at  6  3/5  by  the  Binet  and 
5.9  the  Point  Scale.  He  is  accordingly  classified  as  an  im- 
becile. 

It  was  plain  that  he  should  be  sent  to  a  school  for  the  feeble- 
minded. There  was  for  the  moment  no  vacancy  to  allow  his 
admission.  Concerning  the  possibility  of  couunituient  it  may 
be  noted  that  the  family  refused  to  allow  commitment;  even 
had  the  family  entertained  the  idea  of  commitment,  no  doubt 
the  committed  child  would  have  been  released  from  the  insti- 
tution forthwith  on  the  ground  that  there  were  other  case? 
more  suitable  for  schooling.  Nathan  had,  therefore,  to  be 
supervised  at  home.  He  was  hard  to  manage,  irritable,  quar- 
relsome, and  if  crossed,  disagreeable.  He  threatened  with  a 
toy  pistol  persons  who,  he  thought,  had  injured  him.  He 
would  wait  behind  a  door  with  this  pistol  to  shoot  a  boy  who 
had  hit  him.  He  attended  a  special  class  at  school  and  his 
conduct  improved  a  little  after  his  teacher  obtained  for  him 
a  newsboy's  license.  Nathan  is  now  working  irregularly;  his 
mother  finds  fresh  jobs  for  him  when  he  decides  to  leave  one. 
He  is  very  sensitive  to  children's  taunts  and  comes  home  to 
his  mother  crying  because  somebody  has  teased  him. 

Nathan's  two  siblings,  a  boy  two  years  younger  and  a  girl 
three  years  younger,  are  regarded  as  very  "smart''  and  are 
in  the  high  school  and  grammar  school  respectively  in  proper 
grades  (tested  at  the  hospital  their  age  levels  are  well  up  to 
normal). 

The  social  service  work  in  the  case  of  Nathan  shortly 
brought  out  the  fact  that  his  mother  Sarah  (forty-three)  had 
bad  headaches  and  so-called  "rheumatism"  with  numbness  of 
the  arms.  She  was  examined  in  the  out-patient  department, 
took  hydrotherapeutic  treatment  and  gradually  improved. 

Mrs.  Rosenthal  had  to  take  care  of  the  family  finances 
because  her  husband  Abram,  also  examined  in  the  out-patient 
department,  proved  to  be  nine  years  of  mental  age  (actual 
age  forty-seven).  Mr.  Rosenthal,  a  painter,  seems  to  have 
had  a  fall  upon  his  head  at  about  the  age  of  twenty-four.  He 
had  come  from  Russia  at  the  age  of  nineteen.     He  was  still 


THE    KINGDOM    OF    EVILS  23 1 

unable  to  read  English.  Rosenthal's  friends  thought  that  he 
had  not  been  normal  since  his  fall.  He  had  been  getting 
gradually  worse  and  had  begun  to  suffer  from  spells  of  dizzi- 
ness. He  accordingly  had  to  give  up  his  painting.  At  his 
first  examination  in  the  out-patient  department  there  were 
some  signs  of  lead  poisoning.  He  was  sent  to  a  general 
hospital  for  treatment  (the  same  general  hospital  where  he 
had  been  treated  twenty-three  years  before  for  "concussion 
with  question  of  laceration  of  the  brain,"  evidently  the  basis 
of  his  traumatic  defect-condition).  At  this  general  hospital 
he  was  operated  upon  for  appendicitis.  Aid  had  to  be  given 
to  the  family  in  the  meanwhile  by  two  charitable  agencies. 
Dental  work  was  arranged  for.  Upon  recovery  he  was  helped 
to  get  a  city  position.  His  general  health  had  by  this  time 
much  improved. 

At  the  present  time,  what  with  the  father's  improvement 
in  general  health  and  the  mother's  improvement  as  to  head- 
aches, the  general  situation  is  as  good  as  might  be  expected. 
Once  when  out  of  a  job  Rosenthal  came  to  the  hospital  for 
aid  in  getting  another  city  job.  Of  course  it  is  naturally  not 
advisable  for  any  agency,  and  above  all  a  public  agency,  to 
cause  patients  to  lean  financially  upon  it;  but  a  little  aid  ap- 
plied at  a  critical  time  to  help  restore  physical  or  mental  health 
does  not  necessarily  encourage  a  dependent  attitude.  Our 
assistance  is  often  sought  in  finding  work  when  there  is  no 
thought  of  money  help. 

Concerning  heredity  in  this  family  complex,  we  know  noth- 
ing concerning  Rosenthal  except  that  he  was  one  of  six  chil- 
dren, one  of  whom  died  at  twenty-five  years  but  the  others 
of  whom  lived  to  more  advanced  ages.  The  like  holds  true 
for  the  mother  who  was  one  of  some  nine  children,  all  of 
whom  are  said  to  have  lived  to  a  considerable  age.  Both 
father  and  mother  are  the  only  ones  of  their  siblings  that 
survive.  A  niece  of  the  mother  has  epilepsy.  The  data,  as 
in  the  case  of  many  immigrants,  are  of  no  particular  value 
from  the  eugenic  side.  We  do  not  know  of  any  hereditary  or 
syphilitic  features  in  the  family,  li  Rosenthal  is  a  true  case 
of  traumatic  defect-condition  (that  is  with  mental  symptoms 
due  to  definite  structural  lesion  of  brain  tissue  caused  by  the 
accident)  then  we  should  have  no  reason  for  thinking  that 
the  boy  could  have  inherited  his  feeble-mindedness  from  the 


232  THE    KINGDOM    OF    EVILS 

father,  but  of  course,  we   do  not  know  whether   Rosenthal 
graded  to  normal  at  the  time  of  his  accident. 

Hours  spent  by  Medical  record,  39  pages 

Social  record,  45  pages 
Physician,   i6j4  Social  work: 

Visits,  31 
Psychologist,  5  Interviews  at  hospital,  23 

Telephone  calls,  20 
Social  worker,  64  Letters,  10 

Street  car  conductor,  steady  quiet  fellow;  moron.  Enlisted 
in  the  navy.    Sex  obsessions  and  delusions. 

Case  50.  Bernard  Bornstein,  a  moron,  seventeen  years 
old,  wanted  to  enlist  in  the  navy  to  see  the  world.  His  parents 
refused  permission  because  the  father  was  out  of  work  and 
the  family  dependent  on  the  boy's  wages  (he  was  earning 
between  fifteen  and  twenty  dollars  a  week  as  a  street  car 
conductor).  So  Bernard  ran  away  and  enlisted.  His  first 
day  on  shipboard  he  met  another  Jewish  boy,  who  became  his 
chum  and  in  the  course  of  time  told  him  that  the  other  sailors 
intended  to  make  him  commit  sodomy.  Bernard  believed  this. 
In  the  hospital  he  insisted  that  there  had  been  about  a  hundred 
and  fifty  of  his  shipmates  who  had  followed  him  around  so 
that  he  could  not  do  anything ;  write  a  letter,  or  take  a  bath,  or 
get  to  sleep.  He  said  he  would  wrap  the  blankets  about  him  in 
his  hammock  and  they  would  come  and  tear  them  off.  He  had 
in  fact  complained  to  the  officers,  who  sent  him  to  the  hospital 
with  a  statement  that  there  was  no  basis  in  fact  for  his  ideas. 

This  boy  had  attended  the  public  schools  in  New  York  until 
he  was  fourteen,  made  there  {though  a  moron)  a  fair  record, 
and  had  then  worked  regularly  earning  increasingly  good 
wages.  He  lived  with  his  parents  and  gave  his  weekly  pay 
to  his  mother,  to  whom  he  was  much  attached.  He  was  a  quiet 
fellow  who  spent  his  evenings  at  home  and  went  about  very  lit- 
tle with  other  boys.  In  this  protected  environment  he  was  con- 
tented and  useful,  until  a  sudden  impulse  to  see  the  world  car- 
ried him  into  a  life  of  responsibilities  beyond  his  capacity. 

Hours  spent  by  Medical  record,  29  pages 

Social  record,  o 
Physician,  4]4  Social  work,  0 

Visits,  0 
Psychologist,  i  Interviews  at  hospital,  O 

Telephone  calls,  o 
Social  worker,  o  Letters,  o 


THE    KINGDOM    OF    EVILS  233 

Feeble-minded  recidivist.  Honorable  discharge  from  the 
army. 

Case  51.  Howard  Driscoll  by  psychological  tests  showed 
a  mental  age  a  little  over  ten  years  (twenty-one  at  the  time 
he  was  examined).  He  had  enlisted  in  the  artillery  at  sixteen 
and  had  been  after  three  years  in  camp  sent  to  England  for 
guard  duty,  and  later  to  France  where  he  was  wounded  several 
times  and  gassed.  His  army  record  was  sprinkled  with 
A.W.O.L.'s  but  in  the  end  he  got  his  honorable  discharge.  He 
came  home  but  after  a  short  time  vanished,  turning  up  only 
at  intervals  for  a  few  days.  He  was  even  arrested  once  for 
vagrancy  and  served  a  reformatory  sentence.  Again,  he  broke 
into  the  house  of  an  aunt  and  stole  jewelry  for  which  he  was 
given  three  months  in  jail. 

He  now  enlisted  in  the  navy  and  was  soon  discharged  for 
mental  incapacity.  Some  months  later  he  joined  the  state 
guard  and  was  assigned  to  a  machine-gun  company.  A  week 
later,  whilst  guarding  ammunition,  he  offered  to  relieve  an- 
other guard  so  that  the  latter  could  get  his  dinner.  When  the 
other  man  had  been  gone  for  several  hours,  Driscoll  got  angry, 
left  his  post,  and  went  off  for  four  days.  He  was  then  sent 
to  the  Psychopathic  Hospital  for  examination,  where  he  was 
pronounced  feeble-minded  as  above. 

The  family  gave  an  account  of  a  change  of  character  at 
the  age  of  nine  when  the  boy  had  a  fractured  skull.  After 
this  he  lied  and  stole  and  fought.  He  had  been  twice  in  a 
reform  school.  He  never  kept  at  a  job  for  more  than  a  few 
days  or  a  few  weeks,  with  the  exception  of  a  position  as 
moving-picture  operator  which  he  held  off  and  on  for  two 
years,  leaving  five  separate  times  because  he  did  not  like  the 
"boss"  who  "called  him  down."  Two  months  after  discharge 
from  hospital,  he  was  again  admitted,  sent  in  by  the  court 
on  a  charge  of  larceny.  His  mother  was  distracted,  fearing 
that  the  boy  might  do  some  terrible  thing  that  would  bring 
harm  to  him  and  disgrace  to  the  family.  During  the  two 
months'  interval  between  his  admissions  to  the  hospital,  he 
married  a  girl  whom  he  met  on  the  street  after  a  week's 
acquaintance  and  in  the  full  knowledge  that  she  was  preg- 
nant by  another  man.  This  girl,  as  it  chanced,  had  alsO'  been 
at  one  time  a  patient  at  the  Psychopathic  Hospital,  a  moron 


234  I'HE    KINGDOM    OF   EVILS 

suffering  from  chorea  sent  in  from  a  reformatory  where  she 

had  made  an  attempt  at  suicide. 

For  lack  of  suitable  hospital  provision  for  such  defectives 

as  Driscoll,  the  chances  are  that  the  rest  of  his  life  will  be 

spent  in  intermittent  penal  sentences.     The  girl  he  married 

is  a  similar  problem. 

Hours  spent  by  Medical  record,  13  pages 

Social  record,  i  page 
Physician,  3^  Social  work: 

Visits,  o 
Psychologist,   i  Interviews  at  hospital,  2 

Telephone  calls,  o 
Social  worker,  i^  Letters,  i 

Subnormal  psychopathic  girl.  Illegitimate  child  that  died. 
Unhappy,  quarreling.  Family  known  to  twenty-four  social 
agencies. 

Case  52.  Beatrice  Cellini  has  never  been  in  the  wards  of 
the  Psychopathic  Hospital.  She  has  been  handled  as  an  out- 
patient and  under  the  social  service.  She  came  to  us  alone, 
crying  and  telling  about  her  unhappiness.  We  found  that  she 
had  been  sent  from  another  out-patient  department  with  the 
idea  that  she  might  be  a  mental  case  such  as  could  properly  be 
treated  at  the  Psychopathic  Hospital.  It  proved  that  she  came 
of  a  family  that  had  been  the  subject  of  attention  by  no  less 
than  twenty-four  social  agencies  in  the  City  of  Boston  before 
she  came  to  the  Psychopathic  Hospital  as  the  twenty-fifth. 

She  said  her  home  conditions  were  poor  and  that  she  cried 
a  great  deal.  It  was  partly  her  own  fault.  A  man  had  been 
attentive  to  her  whom  she  wanted  to  marry,  but  "how  could 
a  girl  who  has  had  an  illegitimate  child  marry."  She  said  she 
had  never  gotten  along  with  her  mother,  who  had  nagged  her. 
Moreover  she  quarreled  with  her  brother  and  disliked  her  step- 
father, (There  were  five  stepsiblings.)  She  had  worked  in 
candy  factories  not  earning  more  than  eight  dollars  a  week. 
At  sixteen  she  had  run  away  to  another  state  with  a  man  who, 
according  to  her  story,  assaulted  her.  This  man  afterwards 
went  to  prison.  At  the  age  of  twenty,  according  to  her  story, 
she  was  raped;  at  all  events  she  became  pregnant  and  the  off- 
spring, turned  over  to  the  state,  shortly  died.  It  was  this 
past  that  she  had  so  much  upon  her  mind.  A  brother  was 
dying  of  tuberculosis  in  a  hospital. 

Beatrice  was  given  the  psychometric  tests  (non-English)  and 


THE    KINGDOM    OF   EVILS  235 

was  found  to  grade  at  13.4  years.  The  examination  was  a 
so-called  regular  one.  She  appeared  to  be  overhasty  and 
thoughtless  in  answers  though  she  cooperated  perfectly  well 
in  the  tests.  No  doubt  Beatrice  is  to  be  regarded  as  some- 
what subnormal  or  perhaps  amongst  the  upper  third  of  the 
morons.  Accordingly  only  a  relative  adaptability  to  the  social 
milieu  is  to  be  expected.  The  expected  success  was  scored. 
Beatrice  was  got  to  canvass  for  a  magazine  and  this  work 
appealed  to  her.  She  went  out  amongst  friends  and  acquired 
a  more  cheerful  attitude  to  the  world.  Through  the  counsels 
of  the  social  service  and  otherwise  she  got  upon  much  better 
terms  with  her  mother.  In  some  way,  either  through  the 
passage  of  time  or  the  friendly  conversations  with  visitors,  the 
history  of  her  rapes  and  of  the  illegitimacy  was  either  erased 
from  her  memory  or,  as  the  phrase  goes,  "rationalized."  We  are 
inclined  to  insist  upon  the  value  of  what  may  be  called  the  "psy- 
chiatric touch"  or  attitude.  One  of  the  general  social  workers 
who  had  come  in  contact  with  Beatrice  had  fired  the  following 
adjectives  at  her;  "vain,  idle,  lazy,  selfish,  untruthful,  immoral." 
The  innermost  nature  of  the  psychopathic  personality  re- 
mains to  be  worked  out  (see  Book  III,  Section  XI)  and  the 
relation  of  subnormality  and  moronity  to  psychopathic  per- 
sonality is  a  little  unclear  (see,  for  example,  comments  under 
the  case  of  Marian  Spring,  Case  63,  and  elsewhere).  Beatrice 
varied  much  in  her  attitude  to  the  worker.  Upon  one  visit  she 
would  be  perfectly  amiable  and  compliant,  upon  another,  sullen 
and  disagreeable;  even  within  the  space  of  a  single  visit  her 
mood  might  well  vary  from  sullen  to  amiable.  On  the  whole 
the  variation  was  almost  always  polarized  towards  the  more 
pleasing  mood ;  that  is,  she  responded  well  to  friendly  contact. 
It  was  noted  above  that  she  disliked  her  home  atmosphere; 
nevertheless  she  could  not  be  persuaded  of  the  value  of  going 
away  from  this  disagreeable  home.  Whether  these  moods 
correspond  with  a  slight  tendency  on  the  part  of  Beatrice  to 
the  so-called  cyclothymic  constitution  (see  Book  III,  Section 
IX)  we  may  suspect  but  leave  doubtful. 

Hours  spent  by  Medical  record,  11  pages 

Social  record,   17  pages 
Physician,  3^  Social  work: 

Visits,  6 
Psychologist,   I  Interviews  at  hospital,  3 

Telephone  calls,  13 
Social  worker,  15  Letters,  7 


SECTION  III 

EPILEPTOSES    (epilepsies) 

A  reliable  zuorkman  for  tivo  years  past  disabled  by  epileptic 
seizures.  Drinking  debauch  after  mother's  death:  attack  of 
violence.    Doing  well  at  work  on  relative's  farm. 

Case  53.  Luigi  Silva  was  brought  to  the  Psychopathic 
Hospital  by  the  poHce.  He  had  had  a  fit  and  become  violent 
and  destructive  during  a  heavy  drinking  debauch.  He  was 
still  noisy  and  excited  upon  his  entrance,  unclear  as  to  mental 
processes,  and  quite  inaccessible  to  the  examiner.  When  seen 
he  was  trying  to  break  windows ;  looked  as  though  he  saw 
animals  and  seemed  to  be  trying  to  pick  up  some  things  and 
avoid  others.  He  would  cry  out :  "Why  don't  you  take  that 
thing  off  of  my  shoulder?"  or  again  "It  is  a  lie!" 

Two  days  later  he  was  perfectly  clear.  He  remembered 
having  hallucinations  of  hearing  and  had  a  proper  insight 
concerning  them.  He  was  quite  vague  as  to  his  time  in  the 
hospital.  He  seemed  on  the  whole  rather  dull.  Psychometri- 
cally  he  graded  at  9.2  years;  the  grading  was  rather  irregular, 
suggestive,  that  is  to  say,  of  an  acquired  deterioration.  He 
was  rather  effective  with  the  construction  puzzles  and  fair  upon 
the  memory  tests.  Physically  the  only  positive  points  of  note 
were  moderate  impairment  in  hearing  of  both  ears,  slight 
nystagmus,  and  slightly  excessive  reflexes  on  the  left  side  of 
the  body. 

Silva  had  been  born  in  Boston  of  Italian  parents,  left  school 
at  the  age  of  fourteen  to  go  to  work,  and  had  sometimes  earned 
(doing  heavy  nickel  and  brass  work)  as  much  as  ten  dollars  a 
week.  Later  he  earned  as  much  as  twelve  to  fifteen  dollars 
a  week.  He  had  been  a  reliable  workman,  not  especially 
alcoholic.  At  about  the  age  of  thirty-one  he  had  had  his  first 
attacks  of  an  epileptic  nature,  coming  every  three  or  four 
weeks.  For  the  past  two  years  he  had  been  unable  to  work 
on  account  of  the  seizures.     Of  late  he  had  begun  to  drink  a 

236 


THE    KINGDOM    OF    EVILS  237 

good  deal  of  whisky.  Two  weeks  before  his  arrival  at  the 
hospital,  his  mother  died,  and  after  her  death  he  had  a  very 
heavy  drinking  debauch  whereupon  ensued  the  violent  and 
destructive  attack  above  mentioned. 

Upon  his  discharge  from  the  hospital  he  went  to  live  with 
a  relative  on  a  farm.  The  plan  was  to  keep  Silva  away  from 
the  temptation  of  liquor.  Now  and  then  he  was  to  come  to 
town  to  go  to  the  hospital  clinic.  This  plan  was  carried  out. 
The  patient  helped  about  the  farm,  doing  light  carpentry, 
feeding  animals,  and  cutting  ice.  The  cousin  brought  him  to 
the  hospital  from  time  to  time.  Immediately  after  his  dis- 
charge the  attacks  grew  for  a  period  more  frequent  and  severe. 
He  is  still  having  attacks  which  for  the  time  are  of  milder 
nature.  He  is  said  to  be  improved  mentally,  which  improve- 
ment presumably  means  that  there  are  fewer  after-effects  of 
the  now  somewhat  mitigated  attacks. 

There  are  a  number  of  medical  problems  in  the  Silva  case 
still  unsolved.  Like  all  but  a  small  minority  of  epileptics  he 
exhibits  a  number  of  signs  of  structural  disease  of  the  nervous 
system.  We  do  not  know  why  the  epilepsy  began,  as  it  is 
said  to  have  begun,  after  the  age  of  thirty.  We  have  so  far 
found  no  evidence  of  epilepsy  in  other  members  of  the  family. 

Perhaps  we  might  use  our  ignorance  of  certain  features  in 
the  epileptic  Silva  to  insist  upon  the  importance  of  the  whole 
problem  of  the  epilepsies.  Perhaps  nothing  is  more  harmful  to 
the  victims  than  to  lump  them  all  under  one  term  "epilepsy." 
It  is  just  as  true  that  there  are  numerous  forms  of  epilepsy 
as  that  there  are  various  forms  of  mental  disease.  The  rela- 
tions of  alcohol  to  epilepsy  are  particularly  intriguing.  It 
seems  to  have  proved  that  alcohol  tends  to  produce  more  fre- 
quent and  possibly  more  severe  attacks  of  epilepsy  in  con- 
firmed epileptics.  There  are  also  cases  to  prove  that  alcohol 
'Can  de  novo  produce  epilepsy  in  a  person  without  hereditary 
soil  or  acquired  taint,  and  that  this  epilepsy  may  then  persist 
even  without  the  stimuli  of  further  alcoholism.  But  these 
relations  between  alcohol  and  epilepsy  cannot  be  said  to  be 
thoroughly  established  in  such  a  way  as  to  offer  clear  prin- 
ciples of  prognosis.  Alcohol  is  only  one  cause  or  complication 
of  the  epilepsies.  Following,  on  page  467,  is  a  grouping  of  the 
major  kinds  of  epilepsy;  without  going  into  their  special 
natures,  it  can  be  readily  seen  that  in  the  field  of  epileptology, 


238  THE    KINGDOM    OF    EVILS 

the  social  worker,  to  say  nothing  of  the  psychiatrist  himself, 
must  step  gingerly. 

Hours  spent  by  Medical  record,  19  pages 

Social  record,  6  pages 
Physician,  5^  Social  work: 

Visits,  10 
Psychologist,  i  Interviews  at  hospital,  o 

Telephone  calls,  6 
Social  worker,  17^4  Letters,  3 


Epileptic  who  killed  his  mother.  Convulsions  after  head 
injury. 

Case  54.  Patrick  Donovan,  thirty-six,  killed  his  mother 
and  an  indictment  was  found  against  him  for  murder  in  the 
first  degree.  Patrick  had  given  himself  up  to  the  police,  say- 
ing that  the  beer  he  had  drunk  the  night  before  had  been 
drugged  and  he  did  not  know  what  he  was  doing.  His  sister 
thought  he  had  had  convulsions  the  night  before  the  murder. 
These  convulsions  were  not  necessarily  "epilepsy."  It  is  im- 
portant for  the  social  worker  not  to  confuse  every  fit  of  con- 
vulsions with  the  disease,  epilepsy.  But  these  particular  fits 
turned  out  to  be  verv^  definitely  epilepsy,  due  to  an  injury  ten 
years  before. 

Patrick  had  never  had  any  serious  illness  before  the  age  of 
twenty-six,  although  he  was  said  to  have  been  always  very 
quiet,  sullen,  and  quick-tempered — more  quick-tempered  with 
members  of  his  family  than  with  strangers.  In  short  even 
before  the  fracture  of  his  skull  at  the  age  of  twenty-six  he 
might  be  thought  to  have  shown  somewhat  of  an  epileptic 
temperament,  at  all  events  a  psychopathic  temperament.  Pat- 
rick's brothers  were  all  alcoholic ;  his  paternal  great-grand- 
father had  had  a  mental  disease ;  his  father  had  become  insane 
at  the  age  of  forty. 

The  patient  was  struck  on  the  head  by  a  ledge  weighing 
sixty  pounds  and  was  in  the  hospital  for  some  thirteen  weeks. 
On  the  day  of  the  accident  there  were  nineteen  convulsions. 
From  that  time  forward  convulsions  occurred  frequently 
throughout  his  life,  as  a  rule  at  night.  Patrick  drank  heavily 
of  water  and  had  a  large  appetite.  He  grew  very  jealous 
and  was  unsociable  in  his  family. 


THE    KINGDOM    OF    EVILS  239 

There  could  be  hardly  any  doubt  that  Patrick's  action  was 
epileptic.  His  mother's  body  was  badly  mutilated.  Some 
time  before,  it  now  transpired,  Patrick  had  assaulted  also  his 
sister,  breaking  her  jawbone.  He  had  at  that  time  also  been 
drinking. 

The  psychiatrists  found  Patrick  well  oriented  as  to  time, 
place,  and  person,  nor  could  much  impairment  of  memory  be 
determined.  He  told  of  times  when  his  heart  stopped  beating 
for  long  periods  whilst  he  was  lying  in  bed.  He  told  how  he 
had  a  queer,  shivery  sensation  in  his  body.  Often  he  felt  he 
was  falling  when  he  was  not  falling. 

The  psychologists  found  Patrick  of  the  mental  level  of 
thirteen  years.  There  were  no  irregularities  in  his  mental 
tests  (that  is  to  say,  no  marked  examples  of  his  passing  tests 
of  high  year  levels  while  failing  to  pass  the  tests  of  earlier 
years).  His  associative  processes  proved  to  be  slow,  as  well  as 
all  of  his  responses,  although  he  cooperated  well.  His  vision 
had  been  somewhat  diminished  since  the  accident  and  the 
psychologists  felt  that  his  rating  was  thereby  somewhat 
lowered.  It  seemed  accordingly  that  Patrick  was  not  to  be 
regarded  as  feeble-minded  by  the  mental  tests. 

Physically  there  were  signs  of  the  old  head  injury.  There 
was  no  marked  evidence  of  heart  disease.  Neurologically  he 
showed  sundry  effects  of  his  old  fracture  in  the  shape  of 
elimination  of  the  fields  of  vision  of  the  right  side  and  some 
visual  impairment.  The  X-ray  confirmed  the  history  of  the 
fracture. 

Here  is  a  case  in  which  the  sphere  of  authority  was  in  the 
sense  of  our  Book  I  almost  purely  public — indicted  for  crime 
he  could  almost  at  once  be  determined  to  be  irresponsible  for 
an  act  done  at  the  time  of  epileptic  seizures.  He  could  there- 
fore promptly  be  sent  to  an  institution  for  the  criminal  insane, 
where  no  doubt  he  will  lead  a  tranquil  enough  life  punctuated 
by  occasional  epileptic  seizures.  In  certain  epileptic  cases  there 
is  a  possibility  of  surgical  aid.  But  in  this  instance  the  medical 
details  of  the  examination  were  such  that  surgery  was  not 
recommended. 

What  is  the  province  of  the  social  worker  in  a  case  like 
that  of  Patrick  Donovan?  The  social  worker's  task  is  prac- 
tically confined  to  the  collection  of  data  of  value  in  the  medical 
and  psychiatric  judgment  of  the  case.     In  this  case  various 


240 


THE    KINGDOM    OF    EVILS 


points  concerning  heredity  were  obtained.  Thirteen  agencies, 
relatives,  friends,  and  employers  were  consulted  by  letter,  tele- 
phone, or  interview. 

There  is  no  special  tendency  to  epilepsy  in  the  offspring  of 
the  injured  patient.  It  is  often  of  value  to  reassure  the  rela- 
tives of  traumatic  epileptics  upon  just  this  point.  The  theory 
is  that  the  injury  to  the  brain  which  brings  on  cerebral  con- 
vulsions does  not  injure  the  germ  plasm  and  accordingly  has 
no  effect  upon  heredity.  In  this  instance  there  were  no  epilep- 
tics in  the  family  tree,  but  there  was  mental  disease  on  the 
father's  side  and  there  the  patient's  brothers  were  alcoholic. 
Besides  this  his  somewhat  psychopathic  temperament  must  be 
considered. 


Hours  spent  by 
Physician,  5 
Psychologist,  i 
Social  worker,  5 


Medical  record,  15  pages 
Social  record,  4  pages 
Social  work : 

Visits,  2 

Interviews  at  hospital,  o 

Telephone  calls,  6 

Letters,  6 


Drafted  but  discharged  because  of  epilepsy.  Beginning  of 
symptoms  after  industrial  accident. 

Case  55.  Charles  Lovell  was  sent  from  the  National 
Guard  camp  with  the  statement  that  he  was  depressed,  appre- 
hensive, and  excited.  He  seemed  to  be  trying  to  give  an  im- 
pression of  more  mental  trouble  than  existed.  He  said  he 
"was  crazy  a  year  ago,"  that  his  "mind  gives  way  under 
strain."  He  was  twenty-seven  years  old  and  had  lived  with 
his  mother  in  a  small  town,  where  he  worked  for  a  florist. 
In  school  he  went  to  the  sixth  grade,  leaving  at  the  age  of 
sixteen.     By  psychological  tests  he  graded  irregularly  at  11. 8. 

Five  years  before,  it  was  learned,  while  at  work  in  a  foundry 
he  had  been  hit  on  the  head,  had  lain  unconscious  two  hours, 
and  next  day  became  "raving  crazy"  and  attempted  suicide. 
He  was  in  bed  several  months  and  according  to  his  mother 
did  not  get  "right  in  his  head"  for  a  year.  Thereafter  had 
had  occasional  dazed  spells  and  lapses  of  memory,  such  as  for- 
getting how  he  came  by  money  that  his  mother  had  lent  him. 


THE    KINGDOM    OF    EVILS  24I 

The  diagnosis  was  epilepsy  (no  doubt  traumatic).  The  pa- 
tient was  discharged  from  the  army  and  returned  to  his  old 
job.  Two  months  later  his  mother  wrote  a  frantic  letter  to 
the  social  service  to  ask  advice  as  Charlie  had  received  another 
draft  paper  to  fill  out.  A  statement  of  the  examination  here 
was  sent  her,  and  a  local  physician  was  obtained  to  take  over- 
sight of  the  case. 

Hours  spent  by  Medical  record,  17  pages 

Social  record,   i  page 
Physician,  3J4  Social  work: 

Visits,  0 
Psychologist,  i  Interviews  at  hospital,  I 

Telephone  calls,  o 
Social  worker,  i34  Letters,  4 


Soldier  in  whom  seizures  follozved  vaccine  inoculation. 
Always  siihnormal,  hut  a  steady  lad. 

Case  56.  Frank  Wayne  was  helping  his  father  on  the 
farm  in  a  southern  state  when  he  enlisted  at  the  age  of  nine- 
teen, in  the  coast  artillery,  in  the  spring  of  191 7.  Ten  months 
later,  following  several  vaccine  inoculations,  he  began  to  have 
"fits."  These  attacks  came  on  at  night,  while  he  was  asleep. 
He  would  run  about,  without  regard  to  the  danger  of  hurting 
himself  and  would  sometimes  bellow  and  froth  at  the  mouth. 
He  was  discharged  from  the  service  after  a  period  in  an 
army  hospital  and  sent  home.  His  seizures  now  became  so 
frequent  (he  had  as  many  as  eight  in  ten  hours)  that  his 
father  could  not  control  him,  and  he  was  returned  tO'  the 
government  hospital  and  then  sent  here  for  a  period  of 
observation. 

Before  enlistment  Wayne  seems  to  have  been  a  simple- 
minded  lad  of  good  habits  and  few  interests.  He  went  to 
school  irregularly  because  of  work  on  the  farm  and  left  at 
seventeen.  He  was  considered  by  his  father  to  have  "good 
health"  and  to  be  "sound  mentally."  A  year  and  nine  months 
after  his  first  seizure  his  mental  rating  was  8  by  the  Point 
Scale.  There  had  evidently  been  some  mental  deterioration, 
though  he  was  probably  always  subnormal  in  intelligence.  He 
had   a   speech   impedirnent   and   $eemed   dull,   but   otherwise 


242  THE    KINGDOM    OF    EVILS 

showed  no  peculiarities  while  in  the  hospital.  After  a  few 
weeks  in  the  public  health  hospital  he  demanded  his  discharge 
and  was  again  sent  back  home.  The  diagnosis  in  both  hos- 
pitals was  epilepsy  with  deterioration. 

Hours  spent  by  Medical  record,  12  pages 

Socfal  record,  i  page 
Physician,  334  Social  work: 

Visits,  o 
Psychologist,  i  Interviews  at  hospital,  2 

Telephone  callSj  o 
Social  worker,  2^  Letters,  i 


Policeman  who  enlisted  and  had  night  attacks  after  first 
typhoid  inocidation.     Epilepsy  or  hysteria  f 

Case  57.  John  Bristol  had  been  on  the  Boston  police  force 
before  he  enlisted,  and  was  taken  on  again  after  his  discharge 
from  service,  but  lost  his  position  during  the  police  strike  of 
1919.  While  in  the  army  he  was  boxing  instructor  in  a  train- 
ing camp. 

After  his  first  typhoid  injection  he  had  a  queer  attack  in 
the  night.  These  attacks  continued  to  occur  nearly  every 
night,  always  coming  during  the  night,  always  alike,  and  num- 
bering from  six  to  fifteen  in  a  night.  He  would  suddenly  turn 
over  in  bed,  bury  his  face  and  head  in  the  pillow  until  he  lost 
his  breath,  then  lift  his  head  to  get  air  and  awake  partly 
conscious.  During  the  attack  he  knew  what  was  going  on 
about  him,  but  could  not  control  himself.  He  would  jerk 
about  and  sometimes  hit  himself  in  the  face. 

He  came  into  the  hospital  as  a  voluntary  patient  because 
these  nocturnal  episodes  kept  him  from  feeling  up  to  regular 
work.  He  was  single  and  made  his  home  with  his  family. 
The  father  had  died  in  an  alcoholic  psychosis.  His  case  was 
left  undiagnosed,  for  although  it  was  felt  that  the  trouble  was 
probably  epilepsy,  the  possibility  of  hysteria  could  not  be 
positively  excluded.  An  X-ray  showed  a  slight  clouding  in 
the  pituitary  area,  but  there  was  no  positive  evidence  of  glan- 
dular trouble  as  the  cause  of  the  attacks. 

After  four  months'  treatment  in  the  out-patient  department, 
the  attacks  fell  in  number  to  five  or  six  a  night,  and  Bristol 


THE    KINGDOM    OF    EVILS  243 

felt  encouraged  and  ready  for  regular  work.  He  said  if  he 
could  ever  get  the  attacks  down  to  four  a  night  he  should  feel 
that  he  was  completely  cured. 

Hours  spent  by  Medical  record,  9  pages 

Social  record,  8  pages 
Physician,  3^4  Social  work: 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  7 

Telephone  calls,  4 
Social  worker,  sH  Letters,  10 


SECTION  IV 

PHARMACOPSYCHOSES   ( MENTAL  DISEASES  CAUSED  BY  ALCOHOL 

AND  drugs) 

Expert  physicist:  invahtablc  employee.  Drinking  spells 
when  violent  and  abusive.  Evidence  of  character  anomaly. 
His  fault  mental  or  moral? 

Case  58.  John  Logan,  thirty-nine,  is  a  very  competent 
advertising  man  in  a  business  wherein  a  certain  technical 
knowledge  of  physics  is  of  importance.  Logan  was  born  in 
Ireland  and  had  an  excellent  technical  education  there.  He 
had  come  to  America  in  his  thirty-seventh  year,  having  at  that 
time  been  married  four  years  and  having  two  children.  Within 
a  year  of  his  marriage  he  l^egan  to  drink,  and  he  drank  con- 
tinuously for  seven  months,  during  which  time  he  was  under 
the  care  of  male  attendants.  From  time  to  time  he  had  spells 
of  drinking  in  which  he  would  become  abusive  and  even  violent. 
His  wife  even  left  him  at  one  time,  but  went  back  with  him 
to  his  father's  house  in  Ireland,  where  he  recovered.  Several 
more  spells  of  drinking  followed.  After  one  very  bad  attack, 
his  wife  again  left  him,  carrying  with  her  the  two  children,.- 
and  consulted  a  lawyer.  Upon  this,  Logan  sold  his  house, 
came  to  America,  got  a  good  position  where  his  technical 
ability  counted,  and  eventually  persuaded  his  wife  to  join  him 
once  more. 

Work  piled  up  and,  in  the  course  of  some  six  months,  Logan 
again  began  to  drink  on  the  ground  that  he  was  helped  in  his 
work  thereby.  He  again  jjecame  abusive  with  his  wife,  and 
the  landlord  gave  him  notice  to  quit.  He  turned  upon  the 
landlord,  finally  said  he  was  going  to  hire  a  man  to  shoot  the 
landlord,  and  was  brought  by  the  police  to  the  Psychopathic 
Hospital, 

According  to  Logan's  wife,  her  husband  was,  as  a  rule, 
considerate  enough  yet  objected  to  her  making  friends  or  hav- 
ing any  other  associations  save  with  himself  and  the  children 

244 


THE    KINGDOM    OF    EVILS  245 

He  would  not  take  her  out  of  an  evening,  being  content  to 
stay  at  home,  reading  or  talking.  He  had  never  allov^^ed  a 
door  to  be  unlocked  at  night,  or  a  window  to  stand  open  even 
in  the  hottest  weather.  He  was  apt  to  become  irritable  at 
any  trifling  noise  or  disturbance.  If  his  wife  complained,  he 
would  threaten  to  go  away  and  drink.  In  point  of  fact,  had 
it  not  been  for  the  children,  Mrs.  Logan  said  she  would  not 
live  a  moment  with  her  husband. 

After  two  weeks'  observation  in  the  hospital,  Logan  was 
discharged  and  went  back  to  his  position.  He  was  regarded 
as  "not  insane"  ;  he  was  thought  to  have  been  a  victim  of  acute 
alcoholism  and  not  of  any  alcoholic  psychosis.  The  question 
of  his  being  a  delinquent  was  left  unresolved. 

Is  it  worth  while  to  try  to  clear  up  a  point  or  two  concern- 
ing the  respective  place  in  diagnosis  of  "delinquency,"  "alco- 
holism," and  "alcoholic  psychosis"?  As  we  have  repeatedly 
hinted  in  other  parts  of  this  book,  it  may  well  be  that  the 
psychiatrists  and  the  criminologists  of  the  future  will  show 
that  all  delinquents  are  in  some  sense  psychopathic ;  but  so  far 
as  we  are  aware,  this  proof  has  not  been  brought.  Even  in 
those  instances  in  which  the  character  anomaly  of  a  delin- 
quent is  so  outspoken  that  the  term  psychopathic  fits  pretty 
well,  nevertheless  from  the  legal  and  even  from  the  moral 
points  of  view,  this  anomalous  character  may  remain  per- 
fectly "responsible."  Naturally,  it  is  not  here  our  duty  to 
inquire  the  meaning  of  the  term  "responsible."  We  leave  the 
issue  at  this,  namely,  that  delinquency  is  not  a  psychiatric 
diagnosis.  The  question  of  psychopathy  remains  to  be  deter- 
mined whenever  delinquency  of  whatever  type  is  asserted. 

Somewhat  the  same  situation  holds  with  respect  to  "alcohol- 
ism." Alcoholism  is  obviously  a  social  diagnosis.  It  is  very 
possibly  a  medical  diagnosis.  Sir  Patrick  Manson  has  spoken 
of  alcoholism  as  a  disease  due  to  the  toxin  developed  from 
yeast !  But  assuredly  alcoholism  is  not  a  psychiatric  diagnosis. 
It  is  especially  important  for  the  psychiatric  social  worker  to 
bear  in  mind  that  acute  and  chronic  alcoholism  are  two  forms 
of  social  condition  which  are  not  at  all  necessarily  mental 
diseases. 

Logan  was  dismissed  the  first  time  from  the  Psychopathic 
Hospital  without  a  psychiatric  diagnosis.  That  he  was  a 
victim  of  acute  alcoholism  was  obvious.     That  he  might  pos- 


246  THE    KINGDOM    OF    EVILS 

sibly  be  a  delinquent  (from  his  abusiveness,  violence,  and 
threats  of  homicide)  was  obvious.  That  his  character  was  a 
bit  eccentric  might  also  be  alleged.  But  then  the  "benefit  of 
the  doubt''  had  also  to  be  extended  to  Logan. 

Logan's  employer  had  supposed  that  the  man  would  have 
to  be  discharged.  The  situation  was  explained  to  the  employer, 
who  remarked  that  Logan's  work  was  of  so  much  value  to 
the  firm  that  an  occasional  leave  of  absence  might  be  granted 
to  him  if  necessary.  The  patient  readily  agreed  to  do  no  more 
overtime  work,  to  give  up  alcohol,  and  to  take  more  interest 
in  his  wife's  happiness  and  amusement.  Logan  began  to  take 
a  great  interest  in  the  Men's  Club.  (For  a  brief  description 
of  this  club,  see  case  6,  Alfred  Mack.)  Logan  in  fact  even 
undertook  to  act  as  its  president.  However,  within  four 
months  he  began  to  neglect  the  club,  grew  resentful  of  the 
hospital's  continuing  to  take  an  interest  in  him,  even  threatened 
to  leave  the  state,  said  he  could  not  be  dictated  to,  and  began 
to  think  that  everybody  in  his  office  was  jealous  of  him  and 
working  against  him.  He  began  again  to  drink  heavily  and 
to  abuse  his  wife,  and  even  once  threatened  to  choke  her. 
Upon  this  his  wife  notified  the  social  service  and  Logan  was 
brought  back  to  the  Psychopathic  Hospital  by  the  police.  The 
next  day  he  said  he  was  rather  glad  he  had  come.  He  said 
he  could  not  believe  that  he  had  been  dangerous,  and  it  was 
with  some  difficulty  that  he  could  be  convinced  of  his  change 
of  character. 

He  was  discharged  once  more  after  a  period  of  ten  days, 
again  with  the  diagnosis  of  acute  alcoholism  (not  a  psychi- 
atric diagnosis),  yet  the  notes  show  that  this  man's  character 
anomaly  stood  out  somewhat  in  relief,  so  that  a  suggestion 
of  the  diagnosis  of  paraphrenia  was  offered  by  some  observers. 
This  condition  termed  paraphrenia  is  a  disease  rather  closely 
similar  to  the  so-called  paranoia,  a  condition  with  which  even 
the  laity  has  become  more  or  less  familiar.  It  is  a  disease  in 
which  to  all  external  appearances  the  patient  acts  quite  nor- 
mally. Neither  his  will  nor  his  emotions  are  at  all  out  of 
keeping  with  his  ideas.  It  is  these  ideas  which  are  at  fault. 
Characteristically,  the  disease  runs  a  course  through  (i)  a 
somewhat  indefinite  early  phase  to  (2)  a  phase  of  feeling  per- 
secuted. In  typical  cases,  the  phase  of  persecutory  delusions 
passes  insensibly  over  into    (3J    a  phase  of   grandiose  delu- 


THE    KINGDOM    OF    EVILS  247 

sions  in  which  the  patient  feels  himself  superior  to  or  domi- 
nant in  his  family  and  surroundings.  There  was  in  point  of 
fact  in  Logan's  case  no  very  striking  sign  of  any  grandiose 
trend,  but  his  complainings,  jealousies,  and  ideas  of  persecu- 
tion by  his  working  associates  and  his  wife  seem  consistent 
enough  with  this  diagnosis.  On  the  whole,  however,  there 
was  no  sufficient  argument  for  paraphrenia.  Upon  discharge, 
Logan  seemed  "amiable  though  rather  peculiar."  He  came  a 
number  of  times  to  the  Men's  Club;  then  he  begged  to  be 
excused,  disliking,  as  he  said,  the  hospital  associations  and 
feeling  that  his  fellow  employees  would  see  him  on  the  way 
to  the  hospital.  In  point  of  fact,  so  skillfully  had  hia  hospital 
stays  been  guarded  from  knowledge  that  only  four  or  five 
persons  amongst  his  working  associates  knew  at  all  of  his 
having  been  treated  in  hospital  for  alcoholism. 

Four  years  followed  in  which  Logan's  family  life  was  rea- 
sonably successful.  To  be  sure,  he  remained  capricious  and 
unreasonable,  haggling  over  every  slight  expenditure  and  giv- 
ing his  wife  money  for  food  only.  However,  he  drank  not 
at  all,  enjoyed  his  work,  sent  his  family  on  good  vacation; 
when  his  wife  was  away  himself  did  some  work  about  the 
house,  and  all  went  well.  A  third  child  had  been  born.  The 
family  had  moved  to  pleasant  suburbs,  where  garden  work 
was  the  center  of  interest. 

It  is  to  be  noted,  however,  that  the  prognosis  by  the  medical 
staff  upon  his  second  discharge  remained  a  bit  dubious.  That 
he  might  return  some  day  to  the  hospital  was  an  opinion  that 
stood  for  four  years  in  the  records  without  confirmation. 
Even  when  the  old  situation  recurred  and  he  was  again  a  fit 
subject  for  the  Psychopathic  Hospital,  there  was  a  good  deal 
of  doubt  whether  a  man  who  had  never  received  a  psychiatric 
diagnosis  was  suitable  for  reception.  Could  the  Psychopathic 
Hospital  dogmatically  advise  the  family  or  the  police  to  bring 
a  man  like  John  Logan  back  under  care  ?  Here  lodges  a  large 
arid  important  question  in  the  mental  hygiene  of  the  com- 
munity. We  make  no  doubt  that  in  the  end  such  advice  prop- 
erly supported  by  medical,  psychological,  and  social  data  will 
be  proffered  in  cases  far  less  dangerous  than  John  Logan's. 
However,  we  are  aware  that  in  vast  communities  of  the  United 
States  no  such  interference  with  personal  liberty  and  an 
alcoholic's   privilege   of   the   pursuit   of   happiness   would   be 


248  THE    KINGDOM    OF    EVILS 

tolerated.  No  doubt  sundry  representatives  of  the  judiciary, 
even  in  our  own  community,  might  raise  their  eyebrows  at 
this  kind  of  reaching  out  from  government  to  the  citizenry. 
Looked  at  from  another  point  of  view,  however,  we  are  sure 
that  progress  will  be  in  the  line  of  such  "interference."'  If  it 
be  "interference"  to  preserve  a  man  from  his  own  anomalies 
(to  say  nothing  of  his  wife  and  children),  then  one  might  say. 
Make  the  most  of  it !  The  ideal  day  when  psychopathic  hos- 
pitals throughout  civilized  communities  shall  be  as  open  to 
the  mental  sick  as  general  hospitals  are  open  to  the  somati- 
cally sick,  will  see  far  milder  cases  than  John  Logan's  brought 
to  the  examining  table.  No  matter  what  the  cake  of  custom 
fixates  in  the  minds  of  uncivilized  communities,  the  Psycho- 
pathic Hospital  movement  must  and  will  irresistibly  go  for- 
ward, and  perchance  engulf  those  very  superconservatives  that 
everywhere  block  progress. 

We  wrote  the  above  words  before  the  critical  first  of  July, 
1919,  upon  which  day  national  prohibition  in  our  country 
began.  As  a  matter  of  history,  Logan,  it  appears,  was  influ- 
enced to  start  drinking  again  by  the  suggestion  that  July  i 
was  upon  us  and  that  a  few  last  drinks  might  well  be  in  order. 
He  took  these  drinks,  and  during  the  next  fortnight  at  home 
drank  more  and  more  until  he  became  again  in  the  familiar 
way  excited,  noisy,  threatening,  and  abusive.  Aside  from 
trembling  of  his  hands  and  tongue,  he  was  quite  normal  physi- 
cally. As  always,  he  was  psychometrically  on  a  high  level, 
getting  the  maximum  year  level  that  our  tests  permitted. 
Again  he  received  the  medical  or  social  diagnosis  "alcohol- 
ism," was  regarded  as  non-psychotic,  and  was  discharged. 
What  is  Logan's  prognosis?  National  prohibition  may  settle 
his  fate.  If,  however,  his  spells  of  excitement  and  abusive- 
ness  are  really  not  socially  alcoholic  in  their  origin  but  repre- 
sent some  profound  wave  of  emotional  change  in  Logan,  then 
perhaps  a  new  picture  will  unroll  itself. 

What  has  the  social  work  accomplished  in  the  case  of  John 
Logan?  Such  cases  have  not  been  at  all  frequent.  Physi- 
cians might  well  be  entitled  to  doubt  whether  such  cases  be- 
longed to  the  medical,  and  particularly  to  the  psychiatric,  field 
at  all.  The  question  has  been  raised  several  times  whether 
John  Logan  was  really  a  proper  subject  for  the  Psychopathic 
Hospital.     Would  he  not  perhaps  have  been  straightened  out 


THE    KINGDOM    OF    EVILS  249 

as  effectively  by  treatment  in  some  other  form  of  hospital,  or 
even  as  a  delinquent?  We  are  personally,  however,  strongly 
of  the  opinion  that  the  psychiatric  point  of  view  is  the  best 
available  for  the  elucidation  even  of  such  mild  character  dis- 
order as  we  find  in  Logan.  Logan  himself,  especially  after 
he  had  been  drinking  for  some  time,  no  doubt  felt  that  the 
Psychopathic  Hospital  cast  somewhat  of  a  stigma  upon  him. 
He  was  always  polite  enough  to  the  particular  worker  set  over 
him;  but  his  behavior  was  unmistakably  that  of  a  somewhat 
complaining,  resentful  man.  His  wife,  on  the  other  hand, 
felt  that  John  Logan's  fault  was  far  more  mental  than  moral. 
Perhaps  she  was  taught  by  our  social  workers  so  to  think. 
In  any  event,  without  the  aegis  of  some  hospital,  and  perhaps 
without  the  particular  aegis  of  our  own  in  this  community, 
Mrs.  Logan  would  have  felt  quite  at  a  loss.  No  one  would 
have  picked  up  the  loose  ends  of  the  family  plight;  and  we 
feel  that  an  enormous  debacle  might  well  have  ensued  in  this 
family  without  the  support  afforded  by  social  work. 

The  only  alternative  that  we  can  think  of  to  the  sort  of 
support  afforded  by  the  Psychopathic  Hospital  social  service 
would  be  a  similar  type  of  support  that  one  might  ideally 
think  of  as  possible  under  a  greatly  reformed  criminological 
system.  Should  it  ever  be  possible  for  the  present  system  so 
to  develop  a  fine  system  of  extramural  threads  running  to  all 
parts  of  the  community  of  delinquents  and  near-delinquents, 
then  we  can  ideally  conceive  that  an  extension  of  the  proba- 
tional  system  along  preventive  lines  might  turn  the  same  trick 
that  was  turned  by  the  Psychopathic  social  service  in  the 
Logan  case.  But  we  may  be  permitted  to  point  out  that,  if 
it  remains  doubtful  whether  the  Psychopathic  Hospital  has 
any  right  to  spread  its  wings  over  John  Logan,  then  it  is  per- 
haps more  doubtful  whether  a  benevolent  and  reformed  prison 
system  could  quite  so  readily  spread  its  wings.  Moreover,  we 
think  that  the  wings  of  the  Psychopathic  Hospital  will  always 
be  of  whiter  hue  than  the  wings  of  any  prison  system. 

For  the  administrator  of  such  a  beneficent  system,  whether 
it  stretches  its  wings  from  a  commission  on  mental  diseases  or 
from  a  bureau  of  prisons,  the  problem  presented  by  such  a 
man  as  John  Logan  is  always  a  bit  difficult.  Shall  he  or  shall 
he  not  be  admitted  as  virtually  a  psychopath  when  much  doubt 
rules  whether  he  is  demonstrably  a  psychopath?     Whatever 


250  THE    KINGDOM    OF    EVILS 

the  system,  all  depends,  as  is  ever  the  case,  upon  the  operator 
of  the  system.  Imagine  a  stickler  upon  fine  technical  obstacles 
and  you  will  imagine  an  operator  who  will  fail  whatever  the 
general  virtues  of  the  system.  Wherever  possible  the  com- 
munity should  be  given  the  benefit  of  the  doubt,  and  in  our 
experience,  giving  the  community  that  benefit  incidentally 
inures  to  the  good  of  the  central  figure  in  the  tragedy. 

Hours  spent  by  Medical  record,  11  pages 

Social  record,  22  pages 
Physician,   4  Social  work: 

Visits,    12 
Psychologist,   i  Interviews  at  hospital,  8 

Telephone  calls,   16 
Social   worker,   29  Letters,  16 


First  attack  of  delirium  tremens.  Drank  to  excess  while 
wife  was  in  hospital. 

Case  59.  Patrick  Nolan,  forty,  is  presented  as  a  case  of 
delirium  tremens,  that  most  frequent  of  the  alcoholic  psychoses. 
(In  the  discussion  of  the  next  case,  John  Sullivan,  we  make 
some  note  of  the  differences  between  delirium  tremens  and 
alcoholic  hallucinosis  so  far  as  these  are  of  importance  to  the 
social  worker.)  This  man  was,  according  to  the  mental  tests 
made  by  the  psychological  examiners,  of  a  very  high  rating, 
namely  15.5  years  of  mental  age  (close  to  the  limit  of  age  that 
can  be  tested  by  present-day  psychometric  tests)  and  scored 
in  other  ways  his  intelligence  was  high.  This  test  was  made 
November  19  and  the  patient  cooperated  well  though  he  was 
at  that  time  impatient  to  get  to  his  family  waiting  upstairs. 
He  had  been  admitted  to  the  hospital  four  days  before,  namely 
on  November  15. 

Nolan  was  an  Irishman,  alcoholic  from  the  age  of  twenty- 
two  years.  He  had  been  drinking  to  great  excess  for  some 
days  and  had  l^ecome  very  nervous  and  tremulous.  Two 
nights  before  admission,  that  is  on  the  night  of  November  12, 
Patrick  waked  up  a  family  that  lived  near  him  and  asked  the 
head  of  the  house  to  come  to  the  Nolan  home  and  stay  with 
him  as  he  was  nervous  and  afraid  he  would  die.  His  wife  was 
in  hospital  for  a  slight  operation  and  he  had  resorted  to  whisky 
for  companionship.  He  himself  said  that  while  he  and  whisky 
had  always  been  good  friends  before  that,  after  his  wife  had 


THE    KINGDOM    OF    EVILS  25 1 

gone  to  the  hospital  he  and  whisky  had  become  inseparable. 
His  friend,  Mr.  Doherty,  stayed  with  Patrick  all  night.  Pat- 
rick slept  not  at  all  but  wandered  from  room  to  room.  He 
seemed  a  little  better  next  day  but  in  the  afternoon  talked 
about  seeing  his  dead  brother.  Accordingly  a  physician  was 
called  who  found  all  the  lights  in  the  house  lighted  and  the 
doors  locked.  Patrick  refused  to  see  the  doctor ;  the  police 
came ;  Patrick  then  opened  the  door  and  went  with  them  talk- 
ing about  devils  who  were  getting  him.  So  far  as  his  friends 
knew  or  at  least  would  say,  Patrick  had  never  had  a  similar 
state  before. 

For  two  nights  in  the  hospital  he  continued  to  see  devils 
under  his  bed.  He  was  "somewhat  depressed"  but  the  line 
between  depression  and  a  proper  sadness  is  naturally  hard  to 
draw.  When  he  told  his  story  he  had  become  humorous.  All 
are  familiar  with  the  humor  of  the  Irish  but  it  would  appear 
from  medical  observations  in  alcoholic  psychoses  that  the  so- 
called  "humorism"  is  not  merely  an  Irish  trend  but  is  found 
as  a  somewhat  differential  effect  of  alcoholism  in  a  variety  of 
races. 

Patrick  Nolan  failed  to  see  the  "animals"  which  one  is  sup- 
posed to  see  if  a  victim  of  delirium  tremens.  Perhaps  "devils" 
will  serve  in  their  place.  It  is  just  as  well,  however,  that  the 
case  we  here  choose  to  illustrate  delirium  tremens  is  a  case 
without  the  so-called  zoopsia  or  hallucinations  of  animals. 

Physically  Patrick  was  a  muscular,  gray-haired,  ruddy-faced 
man  having  the  somewhat  characteristic  weather-beaten  alco- 
holic facies.  Aside  from  a  flushed  face  and  widely  dilated 
pupils,  there  was  nothing  of  note  in  the  physical  examination 
save  very  active  knee  jerks.  The  victim  of  delirium  tremens 
is  rather  apt  to  look  more  "sick,"  that  is,  physically  sick,  than 
the  victim  of  alcoholic  hallucinosis  (to  be  considered  in  the 
next  case,  John  Sullivan).  The  facial  flush,  the  tremulous- 
ness,  the  dilated  pupils,  the  look  of  a  certain  confusion  and 
perhaps  fear  combine  to  give  this  impression  of  a  delirium 
tremens  victim  as  looking  "sick."  "Nervousness"  is  a  term 
the  layman  is  apt  to  use  about  this  state ;  but  the  term  is  used 
for  so  many  other  states  that  it  is  of  little  or  no  value  from 
a  standpoint  of  diagnosis.  He  was  discharged  recovered  on 
the  seventh  day  and  his  frank  psychosis  had  thus  lasted  appar- 
ently some  nine  or  ten  days  in  all. 


252  THE    KINGDOM    OF    EVILS 

Patrick  was  now  referred  to  the  social  service.  He  was  a 
married  man  without  children  who  lived  on  the  top  floor  of 
a  three  family  house.  He  was  an  unskilled  laborer  earning 
fifteen  dollars  a  week.  Both  he  and  his  wife  were  church 
members.  In  Ireland  he  had  had  schooling  until  his  thirteenth 
year  and  had  worked  on  a  farm  until  he  was  twenty- four.  A 
brother  had  died  at  forty  of  cirrhosis  of  the  liver,  a  condition 
which  many  books  describe  as  of  alcoholic  origin,  and  which, 
no  doubt,  is  often  alcoholic  in  origin  though  other  factors  must 
probably  enter.  Another  brother  had  died  at  the  same  age, 
forty,  of  heart  disease.  Still  another  had  died  of  tuberculosis 
at  thirty-six,  and  the  fifth  of  the  five  brothers  had  been  a  vic- 
tim of  delirium  tremens  at  one  time  at  the  Psychopathic 
Hospital. 

An  arrangement  was  made  for  the  patient  to  come  to  the 
Men's  Club  but  this  proved  not  feasible.  However,  without 
this  aid,  through  the  very  light  supervision  necessary,  the 
patient  ceased  to  drink  and  it  was  possible  to  close  the  case 
two  months  and  a  half  after  he  first  came  under  observation. 
It  may  be  queried  whether  this  case  was  not  closed  too  early 
and  this  must  be  admitted,  though  no  doubt  with  the  experi- 
ence in  hand  any  renewed  resort  to  alcohol  on  Patrick's  part 
would  have  been  quickly  called  to  the  hospital's  attention  on 
account  of  the  relations  established  with  the  wife. 

Hours  spent  by  Medical  record,  13  pages 

Social  record,  2  pages 
Physician,  3J/2  Social  work: 

Visits,  2 
Psychologist,   i  Interviews  at  hospital,  i 

Telephone  calls,  0 
Social  worker,  5  Letters,  i 


Alcoholic  hallucinosis  in  discharged  real  estate  agent.  Other 
forms  of  alcoholic  psychoses.     Temporary  care  law. 

Case  60.  John  Sullivan,  forty-seven,  was  a  victim  of  a 
so-called  alcoholic  hallucinosis,  a  condition  which  somewhat 
resembles  the  condition  well  known  to  the  laity  under  the 
name  delirium  tremens  and  not  always  easily  told  from  de- 
lirium tremens  on  the  one  hand  and  from  various  other  forms 
of  alcoholic  mental  disease  on  the  other  hand.     Before  the 


THE    KINGDOM    OF    EVILS  253 

era  of  national  prohibition  both  alcoholic  hallucinosis  and 
delirium  tremens  formed  so  important  a  group  of  diseases  that 
no  social  worker  could  fail  to  take  an  intimate  interest  in  their 
nature,  especially  touching  their  prognosis. 

It  is  worth  while  stressing  the  fact  that  the  alcoholic  mental 
diseases  do  not  vary  in  severity  in  proportion  with  the  alco- 
holism which  is  indispensable  to  their  production.  Whether 
there  are  not  some  other  more  essential  factors  that  lie  at  the 
basis  of  alcoholic  mental  disease  in  its  various  forms  is,  at 
present,  unknown.  By  the  administration  of  alcohol  one 
coidd  not  promise  the  production  of  an  alcoholic  psychosis. 
To  be  sure  there  are  some  pseudonormal  forms  of  alcoholic 
mental  disease  that  seem  somewhat  closely  allied  to  drunken- 
ness, a  condition  which  is  not  ordinarily,  or  perhaps  properly, 
termed  a  mental  disease.  The  periodic  form  of  uncontrolled 
drinking  called  dipsomania  and  the  rare  disease  known  as 
pathological  intoxication  are  two  conditions  which  require  the 
most  thorough  observation  and  expert  judgment  to  diagnosti- 
cate. The  victim  of  genuine  dipsomania  is,  no  doubt,  as  a 
rule,  a  psychopath  on  some  broader  and  deeper  basis  than  the 
mere  alcoholic  habit.  .  The  basis  of  the  strange  disease,  patho- 
logic intoxication,  is  perfectly  obscure,  though  the  condition 
may  suggest,  in  its  suddenness  and  relation  with  perfectly  in- 
significant intakes  of  alcohol,  some  peculiar  condition  of  sensi- 
tization that  may  finally  be  explained  when  all  such  matters 
as  shellfish  poisoning,  strawberry  skin  eruptions  and  the  like 
are  explained.  We  insist  rather  upon  these  points  because 
there  is  an  almost  irresistible  tendency  for  the  lay  worker  and 
for  the  inexperienced  physician  to  regard  the  alcoholic  psy- 
choses as,  after  all,  probably  somehow  based  on  the  intake  of 
greater  and  greater  amounts  of  alcohol.  While  upon  the  gen- 
eral topic  we  may  add  that  despite  sundry  assumptions  to 
the  contrary,  it  is  doubtful  whether  particular  kinds  of  alco- 
holic beverages  have  very  especial  outcomes  in  relation  to 
mental  disease.  (The  experimental  absinthe  convulsions  form 
an  important  exception.) 

But  the  great  bulk  of  the  alcoholic  mental  diseases  with 
which  the  social  worker  or  the  court  officer  comes  in  contact 
is,  no  doubt,  composed  of  the  disease  delirium  tremens,  an 
example  of  which  is  the  case  of  Patrick  Nolan  given  above. 
Some  authors  even  deny  that  a  differentiation  can  be  made 


254  THE    KINGDOM    OF    EVILS 

between  the  two  conditions,   delirium  tremens  and  alcoholic 
hallucinosis,  and  they  can  point  out  numerous  transitional  and 
intergrading  forms  of  alcoholic  mental  disease.     Some  cases 
looking  like  delirium  tremens  may  run  along  for  several  weeks 
after  the  manner  of  alcoholic  hallucinosis.      Some  cases  of 
delirium  tremens,  instead  of  presenting  the  hallucinations  of 
vision  that  are  typical  thereof,  present  hallucinations  of  hear- 
ing such  as  we  may  ordinarily  find  in  alcoholic  hallucinosis. 
On  the  other  hand,   alcoholic  hallucinosis,  though   it   is  less 
likely  to  run  the  brief  course  of  less  than  a  fortnight  which 
delirium  tremens  runs,  may  not  seldom  show  hallucinations 
of  sight  like  those  of  delirium  tremens.      It  is  easy  to  see 
that  the  lay  mind  would  here  run  too  readily  upon  diagnostic 
rocks.     To  illustrate  this  fact  we  may  point  out  that  owing  to 
certain  details  in  the  Massachusetts  law,  the  Psychopathic  Hos- 
pital was  not  expected  to  take  cases  of  delirium  tremens  any 
more  than  it  was  expected  to  care  for  cases  of  real  drunken- 
ness.    Nevertheless,  every  year  scores   of  cases  of  delirium 
tremens  were  admitted  to  the  hospital  under  the  false  assump- 
tion that  they  were  cases  of  alcohohc  hallucinosis.    To  be  sure 
humanity  entered  here  to  cloud  the  issue.     No  other  institution 
in  Boston  was  so  well  equipped  materially  or  diagnostically 
to  handle  the  alcoholic  psychoses  as  was  the  Psychopathic  Hos- 
pital.    (It  is  to  this  day  a  sad  commentary  on  the  progress  of 
the  so-called  general   hospitals   that   they  have  not   equipped 
themselves  with  baths,   isolation  rooms,  corps  of   skilled  at- 
tendants, and  proper  diagnostic  specialists  to  meet  the  com- 
plications of  alcoholism,  with  the  result  that  the  jails  have 
had  to  serve  as  hospitals  in  states  not  properly  equipped  with 
psychopathic  units.)     Accordingly  we  were  in  the  habit  of  re- 
ceiving, on  the  ground  of  humanity,  sundry  cases  that  seemed 
to  be  in  extremis  but  which  turned  out  to  be  cases  of  delirium 
tremens.    When  all  is  said  and  done,  the  differential  diagnosis, 
even  in  this  group  of  mental  diseases  which  the  layman  is  apt 
to  think  he  understands  fairly  well,  is  not  easy. 

The  prognosis  of  these  cases  is  particularly  hard,  not  to 
say  often  impossible  to  lay  down,  and  some  cases  of  a  disease, 
ordinarily  fairly  acute,  turn  inexplicably  into  chronic  cases 
requiring  institutional  care  or  its  equivalent,  and  persisting 
with  a  batch  of  hallucinations  and  delusions  like  those  with 
which  the  disease  began,  or  else  subsiding  into  a  deterioration 


THE    KINGDOM    OF    EVILS  ^55 

or  dementia  in  the  midst  of  which  any  very  definite  alcoholic 
features  are  hard  to  descry. 

Before  dismissing  this  topic  of  the  alcoholic  psychoses  in 
general,  we  may  mention  the  existence  of  a  third  group  of 
alcoholic  psychoses  of  an  insidious  onset  and  a  chronic  course, 
cases  that  do  not  necessarily  begin  with  any  acute  form  of 
mental  disease  (though  they  may  do  so)  but  do  not  charac- 
teristically "hallucinate"  (a  slang  phrase  of  the  clinic  having 
reference  to  the  process  of  having  hallucinations ;  that  is,  false 
perceptions  in  some  field  of  sense,  notably  in  the  alcoholic 
psychoses  in  the  spheres  of  vision  and  hearing).  We  offer  a 
case  of  this  third  group  in  that  of  Michael  Piso,  a  case  of 
jealousy  psychosis. 

John  Sullivan  was  a  real  estate  sales  agent.  He  said  his 
business  had  been  going  wrong  for  some  time,  that  he  had 
gone  up  to  Canada  one  day  and  returned  on  the  next  train, 
having  the  idea  that  a  detective  was  following  him;  in  fact 
he  said  he  saw  someone  following  him  and  that  he  heard  some 
men  on  the  train  talking  about  him.  Even  after  entering  the 
hospital  he  said  he  heard  people  remarking  about  how  he 
was  using  other  people's  money. 

Technically  the  fact  that  Sullivan  had  an  idea  that  a  detec- 
tive was  following  him  would  be  regarded  as  a  delusion  or 
false  belief.  If,  however,  he  actually  saw  real  men  and,  not- 
ing their  whispers,  conceived  that  they  were  talking  about  him, 
then  his  status  would  be  technically  regarded  as  one  of  the 
so-called  delusions  or  ideas  "of  reference." 

Whether  Sullivan  actually  had  hallucinations  is  a  matter  of 
some  doubt,  though  he  admitted  hearing  voices  of  no  visible 
source,  but  he  heard  them  rather  vaguely.  The  victim  of  a 
typical  alcoholic  hallucinosis  should,  perhaps,  have  heard  voices 
much  more  definitely  than  did  Sullivan.  The  theoretical  line 
of  separation  between  ideas  "of  reference"  and  hallucinations 
is  sharp  enough,  seeing  that  the  latter  must  be  definite  false 
perceptions,  whereas  the  former  are  a  kind  of  erroneous  idea ; 
yet  the  practical  claim  of  separation  between  these  two  symp- 
toms wavers  tremendously. 

He  had  had  a  history  of  several  weeks  of  such  delusions, 
believing  that  the  police  were  after  him  because  he  had  held 
back  his  rent,  that  people  had  scoffed  at  him,  that  he  was 
ruined  (he  had  actually  lost  money  in  recent  sales).     He  said 


256  THE    KINGDOM    OF   EVILS 

that  his  mind  had  become  rather  confused  of  late  and  that  he 
could  not  think.  In  fact,  he  "must  have  been  insane."  He 
had  once  even  gone  so  far  as  to  threaten  suicide. 

With  all  this  it  may  seem  strange  that  Sullivan  had  actually 
come  to  the  hospital  as  a  voluntary  patient.  When  it  came 
to  signing  the  application  for  his  admission  he,  however,  be- 
came suspicious  and  refused  to  sign.  He  was  accordingly 
admitted  under  the  Temporary  Care  Law  (see  Appendix  C  for 
discussion  of  the  Massachusetts  Temporary  Care  Law,  one  of 
the  measures  without  which  extensive  state  work  with  non- 
committable  psychopaths  is  impossible).  As  he  admitted  hav- 
ing hallucinations  or  other  symptoms  of  a  frankly  psychopathic 
nature,  it  was  perfectly  proper  to  have  a  medical  officer  (not 
upon  the  stafif  of  the  hospital)  make  application  for  his  ad- 
mission. Upon  these  preliminaries,  Sullivan  went  to  the  ward 
without  protest.  This  was  on  May  23  and  by  June  29  it  was 
possible  for  him  to  be  discharged,  as  recovered,  to  the  outt 
patient  department.  He  had  had  seven  days  of  so-called  "tem- 
porary care,"  that  is,  of  care  under  the  law  which  did  not  carry 
him  to  the  probate  court,  but  upon  the  seventh  day,  that  is, 
May  29,  he  was  actually  "committed,"  that  is,  his  case  was 
carried  to  the  probate  court  upon  the  evidence  of  two  expert 
physicians  not  connected  with  the  Psychopathic  Hospital. 

He  was  then  carried  upon  the  books  until  December  29. 
Already  by  May  29  he  had  improved  a  great  deal  so  that  the 
commitment  to  the  hospital  was  really  a  measure  on  the  pa- 
tient's behalf,  to  the  end  that  he  could  have  hospital  care  until 
his  disease  was  over.  He  was  under  hospital  care,  therefore, 
for  a  period  of  about  five  weeks.  At  some  time  in  the  third 
week  he  got  good  insight  into  his  past  condition.  At  this 
point  the  social  service  took  control,  although  the  term  "con- 
trol" might  seem  a  rather  heavy  one  for  this  particular  case. 
Sullivan  was  a  very  amiable  sort  of  man  with  what  may  be 
termed  a  rather  high  empathic  index. ^  The  technique  of 
this  social  care  consisted  in  utilizing  the  Men's  Club  for  hos- 
pital and  human  contacts  and  in  counsel  and  encouragement. 

John's  mother  had  been  for  two  months  at  a  hospital  for 
the  insane  some  years  before,  also  the  victim  of  alcoholic  men- 
tal disease.     One  of  three   brothers  was   also  a  very  heavy 

*  Southard,  E.  E.,  M.D. :  "The  Empathic  Index  in  the  Diagnosis  of  Mental  Dis- 
eases," Journal  of  Abnormal  Psychology,  October,    1918. 


THE    KINGDOM    OF    EVILS  257 

drinker  though  all  three  brothers  and  four  sisters  were  physi- 
cally well.  John's  father  had  died  of  accident.  John  had 
had  little  schooling  but  had  educated  himself.  Though  he 
had  been  a  gardener  in  England  he  had  become  a  real  estate 
agent  in  America.  His  business  had  been  good  until  it  had 
gone  downhill  during  the  last  year,  obviously  the  result  of  his 
alcoholism.  So  far  as  the  history  was  frank,  it  would  seem 
that  before  that  time  he  had  been  drinking  more  moderately 
though  all  through  the  twenties  and  early  thirties  he  had  been 
a  very  heavy  drinker,  apparently  without  any  mental  effects 
of  a  nature  to  interfere  with  self-support. 

Physically  he  proved  entirely  normal  save  his  thinness,  and 
psychiatrically  there  were  no  abnormalities  save  those  men- 
tioned. He  explained  that  he  had  taken  the  trip  to  Canada  with 
a  vague  idea  that  he  was  going  to  start  anew  there. 

We  find  medical  notes  of  reports  in  July,  August,  Septem- 
ber, November,  February,  March,  May.  These  notes  show 
that  there  was  no  return  of  symptoms  and  that  Sullivan  was 
making  a  good  deal  of  headway  with  his  debts  and  with  his 
business.  Pari  passu  with  these  medical  notes  we  find  social 
service  notes  in  February,  March,  April,  and  May  of  the  year 
following  his  attack  and,  in  fact,  in  May  the  case  was  closed 
by  the  social  service.  The  social-service  notes  had  told  of 
visits  at  Sullivan's  home  and  of  advice  concerning  his  coming 
to  the  Men's  Club.  The  economic  problem  was  not  in  the 
foreground,  as  the  wife  kept  a  lodging  house. 

Hours  spent  by  Medical  record,  lo  pages 

Social  record,   i  page 
Physician,   7%  Social  work: 

Visits,   3 
Psychologist,  o  Interviews  at  hospital,  2 

Telephone  calls,  I 
Social  worker,  5^/^  Letters^  4 


Root  of  family  dissension  may  be  disease  /)f  one  member. 
Acute  alcoholic  hallucinosis;  chronic  inebriety;  morbid  temper- 
ament. 

Case  61.  If  we  examine  a  social  case  card-catalogue,  we 
shall  find  case  after  case  of  so-called  family  dissension.  We 
say  "so-called"  not  because  the  term  is  meaningless,  but  be- 
cause cases  left  with  the  designation   family  dissension  are, 


258  THE    KINGDOM    OF    EVILS 

we  believe,  cases  not  properly  analyzed  as  to  the  form  of  evil 
at  work.  That  form  of  evil  may  as  readily  be  disease  in  one 
or  other  member  of  the  family  as  any  other  of  our  major 
groups  of  evil.  Thus  Margaret  Murray,  a  Scotch  woman  of 
thirty-nine,  was  living  in  New  Hampshire  with  her  six-year- 
old  daughter  Pearl,  apart  from  her  very  reputable  husband, 
an  iron-worker  earning  some  thirty  dollars  a  week.  The 
"symptom''  catalogue  stood  as  follows : 

Social  symptoms: 

Inebriety   (chronic) 

(?)   Insane  commitment 

(  ?)  Neglect  of  child 

(?)   Immoral  influence  on  child 

Marital  discord 

Arrest 
Social  diagnosis: 

Family  dissension 
Medical  diagnosis: 

Acute  alcoholic  hallucinosis 

We  hold  that  the  medical  diagnosis  in  this  case  is  the  social 
diagnosis  and  that  family  dissension,  though  a  perfectly  cor- 
rect term  for  the  social  conditions  found,  is  not  the  caption 
most  helpful  in  determining  social  treatment.  Chronic  in- 
ebriety is  set  down  as  one  of  the  social  factors :  a  fortiori, 
acute  alcoholic  hallucinosis  is  another  and  even  more  command- 
ing factor,  since  (a)  this  disease  brought  Mrs.  Murray  to  the 
Psychopathic  Hospital  and  (b)  its  prognosis  and  treatment 
(whether  by  costing  confinement  in  a  state  hospital  or  not) 
will  influence  every  social  step  taken.  In  short  we  would  pre- 
fer to  place  this  case  among  the  Morbi  rather  than  among  the 
Vitia  where  family  dissension  would  tend  to  leave  it.  Let  the 
morbid  factor  be  removed,  and  the  moral  factor  can  remain — 
i.e.,  Mrs.  Murray  would  then  have  her  chronic  inebriety  to 
face  (provided  that  in  her  case  the  habit  is  not  itself  a  disease). 
Let  the  inebriety  be  removed,  and  there  might  still  be  a  basis 
in  morbid  temperament  or  bad  habits  for  family  discord. 

Let  us  examine  enough  of  the  facts  to  demonstrate  the 
issue.  Mrs.  Murray  had  drunk  to  excess  and  had  been  twice 
arrested  for  drunkenness  (chronic  inebriety).  She  came  to 
Boston  and,  whilst  working  in  an  institution,  developed  the 
symptoms  that   brought   her   to   the   Psychopathic   Hospital. 


THE    KINGDOM    OF    EVILS  259 

There  she  had  hallucinations  of  hearing  and  told  (delusional) 
stories  of  her  husband's  abuse  of  her.  There  was  even  raised 
the  question  of  commitment.  The  husband  was  by  now  dis- 
heartened and  antagonized  and  had  begun  to  regard  his  wife 
as  irresponsible.  There  was  discord  over  the  question  whether 
she  should  live  with  husband  and  daughter,  should  take  the 
daughter  with  her,  or  leave  the  daughter  with  her  father. 
Mr.  Murray  felt  that  daughter  Pearl  might  suffer  immoral 
influences  from  her  drunken  mother.  Upon  study  of  the  case 
it  appeared  to  the  social  workers  that  the  child  could  hardly 
be  unaware  of  her  mother's  drunkenness.  It  was  on  this 
account  that  the  list  of  social  symptoms  contained  the  two 
questions  "neglect  of  child?"  and  "immoral  influence  on 
child?" 

The  efforts  of  the  social  service  were  summed  up  as  fol- 
lows : — 

1.  In  arranging  for  temporary  care  for  patient  and  child 
upon  the  former's  discharge  from  the  hospital  until  the  hus- 
band could  be  located  and  until  employment  was  found  for  her. 

2.  In  making  an  investigation  of  the  family  situation  to 
understand  the  facts. 

3.  To  give  advice  and  cooperation  to  both  the  patient  and 
her  husband  as  they  are  working  out  their  readjustment. 

If  we  take  the  phrase  "working  out  their  readjustment" 
upon  the  simple  basis  of  family  dissension,  we  should  hardly 
avoid  being  influenced  by  the  phrase  itself.  Family  dissen- 
sion clearly  points  to  moral  difficulties  within  the  sphere  of 
what  we  have  in  this  book  termed  Vitia.  Family  dissension 
does  not  at  all  necessarily  point  to  disease  (Morbi).  The  man 
in  the  street  and  the  social  worker  can  hardly  help  feeling  that 
family  dissension  is  a  matter  of  ingrained  temperament  dif- 
ficult to  train  by  moral  methods,  difficult  or  impossible  to 
reeducate  by  the  intellectual  route  alone  and,  even  if  psycho- 
pathic, by  the  same  token  harder  than  ever  to  meet.  In  short, 
the  social  worker,  should  she  content  herself  with  the  social 
diagnosis  family  dissension,  might  believe  that  she  was  doing 
the  charitable  thing  by  her  patient.  Family  dissension  as  a 
moral  matter  sounds  less  heinous  than  family  dissension  as 
a  matter  of  disease. 

But  let  us  look  into  the  facts.  As  a  matter  of  the  actual 
situation  and  its  outcome,  the  social  condition  family  dissen- 


26o  THE    KINGDOM    OF    EVILS 

sion  proved  to  be  almost  entirely,  if  not  quite,  fear  of  a  rather 
acute  mental  disease  or  the  so-called  hallucinosis.  That  there 
was  any  deep  underlying  psychopathic  trend  of  temperament 
is  extremely  doubtful.  Even  if  Mrs.  Murray  became  alco- 
holic through  some  deep  trend  of  her  nature,  there  is  no  proof, 
theoretical  or  practical,  that  this  temperamental  trend  would, 
in  and  by  itself,  lead  to  family  dissension.  Accordingly,  we 
hold  that  our  proof  is  positive,  that  the  social  diagnosis  in 
the  case  of  Mrs.  Margaret  Murray  should  be  alcoholic  mental 
disease,  in  particular  acute  alcoholic  hallucinosis.  We  hold 
that  the  social  prognosis  depends  upon  the  medical  diagnosis 
and  prognosis.  We  hold  that  family  dissension  is  an  effect 
rather  than  a  cause  and  is  probably  removable.  We  hold  that 
the  questions  raised  concerning  neglect  of  child  and  immoral 
influence  upon  the  child  by  her  mother  are  questions  which 
would  be  removed  by  a  solution  of  the  mother's  alcoholic 
problem.  Likewise  we  hold  that  the  arrest  and  the  question 
of  commitment  of  Mrs.  Murray  to  a  chronic  institution  (a 
question  raised  during  her  temporary  care  whilst  she  was 
recovering  from  the  acute  effects  of  her  alcoholic  psychosis) 
are  likewise  purely  secondary  products  of  the  situation. 

We  should  also  like  to  call  attention  to  the  fact  that  the 
phrase  "chronic  inebriety''  which  stands  at  the  head  of  the 
list  of  social  symptoms  in  this  case  is  likewise  somewhat  mis- 
leading. To  be  sure  the  acute  mental  disease  known  as  alco- 
holic hallucinosis  was,  in  this  case,  incidental  to  a  chronic  in- 
ebriety. It  is  also  true,  no  doubt,  that  alcoholic  hallucinosis 
is,  as  a  rule,  incidental  to  a  chronic  inebriety,  but  it  is  not  at 
all  clear  that  chronic  inebriety  must  necessarily  or  in  any 
large  proportion  of  cases  lead  to  alcoholic  hallucinosis.  •  As 
one  author  rather  paradoxically  said,  "The  causes  of  delirium 
tremens  are  still  obscure."  The  same  holds  for  the  allied 
disease,  alcoholic  hallucinosis,  the  causes  of  which  are  per- 
haps still  more  obscure  than  those  of  delirium  tremens  itself. 
Neither  of  these  diseases  is  at  all  proportional  to  the  amount 
of  alcohol  consumed  by  the  victims  nor  to  the  duration  of 
the  habits  of  inebriety.  Nor  can  we  say  that  the  prognosis 
of  cases  of  delirium  tremens  or  of  alcoholic  hallucinosis  at 
all  varies  with  the  duration  or  severity  of  the  alcoholic  bad 
habit.  We  may  be  permitted  to  add  that  chronic  inebriety 
shares  with  family  dissension  the  pretty  distinct  intimation 


THE    KINGDOM    OF    EVILS  26 1 

that  we  are  dealing  with  bad  habits  and  vices  rather  than  with 
deficiencies  in  the  patient's  education  or  psychopathic  tempera- 
mental tendencies. 

The  general  social  worker  must  bear  in  mind  these  intima- 
tions of  the  social  phrase.  The  psychiatric  social  worker 
quickly  learns  the  more  obvious  pitfalls  of  phraseology,  but 
each  type  of  social  worker  and  the  physician  himself  must 
guard  against  throwing  all  cases  of  family  dissension  and  oil 
cases  of  chronic  inebriety  over  into  the  disease  group.  It 
must  be  plain  from  the  general  drift  of  our  contentions  in 
this  book  that  disease  must  be  considered  as  a  primary  hy- 
pothesis and  not  necessarily  as  a  statistical  probability.  De- 
ficiencies in  education  leading  to  family  dissension  or  to  chronic 
inebriety  are  even  less  statistically  probable  as  a  matter  of 
actual  fact — still,  we  must  consider  the  hypothesis  of  faulty 
education.  Nevertheless,  if  we  are  entitled  to  give  over  the 
psychopathic  hypothesis  and  the  maleducational  hypothesis, 
then  we  shall  be  reduced  to  the  hypothesis  of  moral  deficiency 
or  perversion.  If  we  are  reduced  to  this  hypothesis,  we  shall 
find, far  more  trouble  in  the  process  of  readjustment  for  every- 
body,— as  some  might  say  nine  parts  of  internal  readjustment 
to  one  part  of  external  and  merely  social  readaptation.  Family 
dissension  might  conceivably  be  an  almost  purely  legal  diffi- 
culty owing  to  perfectly  logical  disagreements  on  the  part 
of  different  members  of  the  family  concerning  (let  us  say) 
financial  arrangements ;  but  of  that  rare  possibility  there  was 
no  question  in  the  Murray  case.  Nor  \yas  there  any  question 
of  a  purely  economic  basis  for  the  dissension  in  this  family. 

The  social  analysis  of  the  Murray  case  leads  us,  in  the  end, 
to  placing  an  acute  and  curable  alcoholic  mental  disease  sharply 
in  the  foreground.  The  social  prognosis  becomes  extraordi- 
narily brighter  than  it  would  be  if  we  took  family  dissension 
prima  facie  as  the  root  difficulty.  We  are  dealing  with  an- 
other sample  of  the  well-known,  though  somewhat  paradoxical, 
plight,  the  situation  that  it  is  rather  better  to  be  sick  than 
to  be  vicious. 

Hours  spent  by  Medical  record,  6  pages 

Social  record,  7  pages 
Physician,  3^  Social  work: 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  2 

Telephone  calls,  22 
Social  worker,  7  Letters,  15 


262  THE    KINGDOM    OF   EVILS 

Feeble-minded  teamster  ten  years  married  to  a  good  wife, 
suffers  from  alcoholic  "jealousy-psychosis."  Violent,  abusive. 
Improvement.     Family  difficulties:  poverty,  sickness. 

Case  62.  There  are  hardly  more  intriguing  cases  than 
those  of  jealousy  in  alcoholics.  Psychiatrists  recognize  a  pe- 
culiar alcoholic  "jealousy  psychosis,"  sometimes  conceiving 
that  the  onset  of  sexual  impotence  on  the  part  of  the  alcoholic 
leads  up  by  somewhat  natural  steps  to  the  belief  that  the  spouse 
is  in  love  with  a  rival.  Now  there  is,  perhaps,  especially  in 
alcoholic  families,  always  a  possibility  that  there  is  some  ac- 
tual fire  under  the  delusional  smoke.  The  psychiatrist,  and 
even  the  social  worker  who  comes  in  close  contact  with  family 
conditions,  may  be  for  a  long  time  in  doubt  as  to  the  actual 
facts.  In  alcoholic  communities  the  psychiatrist  often  feels 
himself  entitled  to  suspect  alcohol  in  any  case  of  delusions  of 
jealousy.  Yet  the  psychiatrist  has  constantly  in  the  back  of 
his  mind  sundry  exceptional  instances  in  which  jealousy  delu- 
sions appear  in  wo;2-alcoholic  persons,  for  example  in  victims 
of  schizophrenia  (dementia  praecox).  The  social  worker's 
data  become  of  prime  importance  in  making  exactly  this  deci- 
sion between  alcoholic  jealousy-psychosis  and  dementia  prae- 
cox with  sex  ideas. 

Michael  Piso  had  been  jealous  of  his  wife,  according  to 
his  history,  ever  since  their  marriage.  As  a  jealous  husband 
he  questioned  her  about  everything — at  one  time  accusing  her 
of  immorality  with  a  lad  of  nineteen  years.  They  had  been 
married  for  ten  years,  and  his  wife  was  in  point  of  fact  an 
exceptionally  good  woman.  There  were  three  living  children. 
Michael  had  been  alcoholic  for  some  fifteen  years.  He  always 
made  excessive  sex  demands  upon  his  wife  and  twice  tried  to 
choke  her  when  these  demands  were  not  met.  He  was  a  team- 
ster and  worked  in  one  place  throughout  his  married  life.  At 
one  time  he  developed  an  abscess  in  the  right  ear  and  com- 
plained of  severe  headaches.  The  psychiatrist  brought  up  a 
question,  upon  his  arrival  at  the  hospital,  of  organic  brain 
disease  but  was  even  then  convinced  (by  such  portion  of  the 
story  as  was  available)  that  he  was  probably  a  case  of  alco- 
holic psychosis  and  was  at  the  same  time  feeble-minded.  This 
combination  of  diagnoses  proved  in  fact  the  final  one,  and 
he  was  discharged  as  a  high-grade  moron  with  alcoholic 
psychosis. 


THE    KINGDOM    OF    EVILS  263 

Just  before  entering  the  hospital  he  threatened  to  buy  a 
pistol  and  attacked  his  wife.  He  had  left  work  about  a  week 
before  entering  the  hospital  and  had  grown  increasingly  jeal- 
ous of  his  wife  and  imperious  as  to  sex.  A  year  before  he 
had  had  a  severe  headache  which  had  thrown  him  out  of  work 
for  ten  days,  and  at  that  time  he  vomited  and  had  blurring  of 
the  eyes.  As  to  heredity,  one  of  his  children  had  had  convul- 
sions and  a  cousin  died  insane  in  a  state  hospital. 

The  psychologist  could  find  no  marked  irregularity  in 
Michael's  reactions;  and,  finding  his  mental  age  according  to 
the  Point  Scale  to  stand  at  11.6  (Binet  103/5)  years,  made 
the  diagnosis  of  feeble-mindedness.  It  might  be  inquired 
whether  this  feeble-mindedness  was  more  apparent  than  real. 
Seeing  that  Michael  had  been  heavily  alcoholic  for  fifteen 
years,  we  might  regard  him  as  a  victim  of  alcoholic  deteriora- 
tion. Some  victims  of  alcoholic  deterioration  do  give  a  low 
test  of  this  sort,  even  without  marked  irregularities ;  on  the 
whole,  however,  a  victim  of  acquired  psychosis  is  very  likely 
to  show  some  traces  of  inability  to  pass  tests  of  the  earlier 
years  of  the  scale  {e.g.,  seven-year-old  tests)  at  the  same  time 
that  he  passes  the  tests  of  the  higher  scale  years  {e.g.,  eleven- 
year-old  tests).  Michael  was  a  teamster,  and  his  work  no 
doubt  did  not  as  a  rule  require  behavior  more  complicated  than 
that  of  the  mental  age  level  of  1 1.6. 

The  psychiatrists  could  upon  physical  examination  find  no 
sign  of  brain  tumor,  nor,  with  the  exception  of  pyorrhea,  was 
there  any  marked  condition  of  disease  in  the  body. 

There  was  considerable  doubt  whether  he  had  ever  had 
hallucinations,  although  there  was  a  possibility  of  auditory 
ones.  The  delusion  of  infidelity  on  the  part  of  his  wife  he 
now  very  well  concealed.  After  some  three  weeks  in  the  hos- 
.pital  he  grew  quieter,  remarked  that  he  had  one  night  heard 
a  voice  about  his  wife,  saying,  "Do  not  trust  her" — a  voice 
which  he  knew  to  be  imaginary, — and  now  claimed  he  had 
never  suspected  his  wife  of  anything  and  that  he  trusted  her 
absolutely.  Upon  his  discharge  he  seemed  to  be  quite  normal 
except  for  slight  sidewise  movements  of  both  eyes  (nystag- 
mus), which  were  however  held  very  quietly  when  looking  at 
some  definite  point.  He  was  now  discharged  to  the  social 
service,  which  had  to  face  family  conditions  of  some  compli- 
cation.    The  picture  of  the  results  obtained  may  be  got  from 


264  THE    KINGDOM    OF    EVILS 

the   following  transcript   (names,  as  always,  changed).     See 
below  for  general  comment  on  these  results. 

July  8-October  8,  1916 

Social: 

Patient  has  been  steadily  at  work  earning  thirteen  dollars  a 
week.  Expected  to  go  to  Men's  Club,  but  did  not  come  to 
September  or  October  meetings. 

Physical: 

Patient  has  only  once  had  headache  of  late.  Has  worn 
glasses  for  four  years  and  will  have  eyes  reexamined. 

Mental: 

Patient  has  not  been  drinking  except  once.  Wife  still  com- 
plains of  sexual  demands  but  commends  him  in  every  other 
way. 

October  8,  1916-January  8,  191 7 

Social: 

Family  visited  five  times.  Mrs.  Piso  pregnant  and  without 
clothes  to  get  outdoors  in.  Children's  shoes  worn  out  and  no 
warm  clothes.  Clothes  taken  and  arrangements  made  to  send 
wife  to  Boston  Lying-in  Hospital  as  free  patient  with  permission 
of  own  doctor.  Dr.  McDonald.  Patient  could  not  be  per- 
suaded to  let  wife  go,  so  visitor  arranged  to  have  district  nurse 
give  prenatal  care.  Patient  is  working  steadily  and  brings 
home  wages  every  -w^eek,  and  comes  in  every  night  at  six 
o'clock.  Patient  has  walked  to  Boston  two  evenings  with  wife 
and  about  Charlestown  once  or  twice.  Wife  is  anxious  to  have 
everything  in  good  order  around  the  house  before  confinement. 
There  is  nothing  abnormal  in  wife's  condition  and  she  feels 
well.  Children  are  well  now  and  have  had  no  colds  since  they 
have  been  able  to  go  outdoors.  Dr.  McDonald  to  take  confine- 
ment case. 

Physical: 

Patient  is  well. 

Mental: 

Patient,  is  not  drinking  now,  at  least  wife  sees  no  signs  of  it. 
He  was  very  firm  about  not  letting  wife  go  to  hospital. 


THE    KINGDOM    OF   EVILS  265 

January  8-April  8,  191 7 
Social: 

A  baby  girl  was  born  January  23  and  baby  and  mother  did 
well  in  care  of  Dr.  McDonald  and  the  district  nurse.  Patient 
has  worked  steadily  and  brought  money  home.  Patient  has 
had  no  recreation  except  to  visit  his  father  who  is  ill.  He 
spends  his  leisure  at  home  with  the  children  of  whom  he  is 
very  fond.  Wife  took  cold  in  her  breast  and  had  to  stop  nurs- 
ing the  baby  for  a  few  days,  but  recovered  satisfactorily.  Is 
having  teeth  treated.  The  baby  has  some  stomach  trouble 
and  has  not  gained  very  fast,  but  dispensary  doctor  says  she  is 
all  right. 

Physical: 

Patient  has  been  well  except  for  trouble  with  hemorrhoids 
which  lasted  about  two  weeks  in  March, 

Mental: 

Patient  drank  about  a  week  after  birth  of  baby  but  stopped 
because  it  was  so  hard  on  family.  He  is  very  agreeable  and 
helpful  at  home.  He  came  once  to  Men's  Club  meeting  and 
would  have  come  two  other  months  but  his  wife  was  ill  and 
the  distance  great. 

April  8,  1917-July  8,  1917 

Social: 

Patient  worked  steadily  and  was  kind  and  devoted  to  the 
family  during  April  and  the  early  part  of  May,  Patient's 
father  died  May  12,  and  he  drank  steadily  for  a  month.  For 
the  last  four  weeks  he  has  drunk  nothing.  Wife  and  children 
are  rather  tired  and  run  down  and  have  been  registered  at  the 
Country  Week  for  a  two  weeks'  vacation.  The  baby  has  been 
under  dispensary  care  and  is  doing  well. 

Physical: 

Patient's  work  has  tired  him  and  he  has  suffered  from  head- 
ache occasionally  but  has  not  been  induced  to  have  his  eyes 
examined.    He  has  not  worn  his  first  glasses  faithfully. 

Mental- 
While  patient  was  drinking  he  became  exceedingly  jealous 
and  irritable.     His  sexual  demands  were  excessive.     When  not 
drinking   he  has   been  agreeable  and  helpful   at  home.     At- 
tended the  Men's  Club. 


266  THE    KINGDOM    OF   EVILS 

July  8,  1917-October  8,  1 91 7 
Social: 

Patient  has  been  working  steadily  in  spite  of  heavy  work 
and  long  hours.  His  pay  has  been  raised  to  seventeen  dollars 
per  week.  He  has  not  been  drinking  for  four  months.  After 
Mary  recovered  from  diphtheria,  patient's  wife  and  children 
had  a  Country  Week  vacation  for  two  weeks,  which  was  very 
beneficial  to  them  all.  Mrs.  Martin  kept  house  for  patient 
while  they  were  gone.  Patient  and  his  wife  go  to  Boston 
together  Saturday  nights  to  do  their  shopping  now,  instead  of 
patient's  going  alone  and  getting  drunk.  Patient  and  all  the 
family  are  in  need  of  warm  clothes. 

Physical: 

Nothing  of  note. 

Mental: 

Patient  has  been  very  kind  to  and  considerate  of  his  wife. 
He  missed  the  family  greatly  while  they  were  away  on  their 
vacation,  and  met  them  at  the  station  with  his  express  team 
when  they  returned.  He  is  very  fond  of  the  children,  and  says 
that  he  prefers  to  spend  all  he  earns  for  his  wife  and  them, 
"instead  of  wasting  it  for  drink." 

Thus,  medically  the  health  of  the  wife  and  children  was 
supervised  and  a  vacation  procured  for  them.  It  proved  pos- 
sible also  to  improve  the  housekeeping  by  concrete  advice  as 
to  procedure.  The  wife  was  told  "to  be  nice"  to  her  husband, 
to  "dress  up"  Saturdays  for  the  purpose  of  taking  her  hus- 
band shopping.  She  let  him  buy  a  derby  hat,  saying,  "You 
have  to  let  them  have  something  when  they  work  so  hard." 

On  the  economic  side  she  was  discouraged  from  working  to 
supplement  the  family  income,  so  that  Michael  should  not  be 
dissuaded  from  trying  to  get  a  better  paying  job.  Economi- 
cally also  the  family  was  helped  out  by  means  of  clothing,  be- 
cause after  all  Michael's  wages  were  too  small  for  the  familv 
needs.  This  case  showed  all  the  forms  of  evil  discussed  in 
this  book  except  the  legal.  No  doubt  the  mental  issue  was 
the  dominant  one  and  the  economic  probably  stood  next;  but 
in  the  family  adjustment  the  social  worker  employed  means 
quite  beyond  the  merely  psychiatric  and  economic  range,  to 
teach  the  housewife  much  of  value  to  the  family  specifically 
and  to  improve  the  moral  situation  between  the  spouses. 


THE    KINGDOM    OF    EVILS  267 

Hours  spent  by  Medical  record,  36  pages 

Social  record,  33  pages 
Physician,  6j4  Social  work: 

Visits,  46 
Psychologist,    i  Interviews  at  hospital,  8 

Telephone  calls,  17 
Social  worker,  78  Letters,  27 


Morphinism  and  alcoholism  in  a  woman  of  psychopathic 
personality.  Fantastic  story  of  a  murder.  A  social  service 
failure. 

Case  63.  Marian  Spring  we  present  to  illustrate  morphin- 
ism, though  there  is  hardly  any  doubt  that  she  is  an  example 
of  a  so-called  psychopathic  personality  (see  Book  III,  Section 
XI  for  other  examples). 

Marian  had  been  brought  up  in  her  middle-class  family  and 
upon  leaving  school  at  fourteen  had  spent  two  years  in  a  con- 
vent. Then  after  living  some  years  at  home,  at  nineteen  she 
began  to  work  in  mills.  While  she  was  a  mill  operative,  she 
began,  in  her  twenty-first  or  twenty-second  year,  to  drink  with 
another  girl,  and  apparently  this  drinking  began  after  the 
death  of  her  mother.  Finally  she  got  to  drinking  hard  enough 
to  interfere  with  her  work,  and  at  last  began  to  make  her  rather 
checkered  round  of  institutions,  spending  two  years  in  an  in- 
sane hospital  from  the  beginning  of  her  twenty-fifth  year,  and 
then  being  confined  in  three  reformatories  up  to  a  period  of 
four  months  before  her  admission  to  the  Psychopathic  Hos- 
pital. In  the  brief  intervals  between  these  institutional  deten- 
tions she  worked  at  housework  which  she  did  very  capably 
and  nicely.  Marian,  however,  had  few  friends  and  apparently 
had  chosen  her  associates  from  amongst  the  most  undesirable 
of  the  mill  workers.  These  associates  were  so  undesirable  that 
they  were  not  allowed  at  home  and  the  family  had  become 
quite  discouraged  with  Marian. 

She  was  a  well-developed  and  nourished  woman  with  rather 
prominent  eyes  and  a  certain  asymmetry  of  face.  She  was 
physically  energetic  and  sturdy,  but  said  she  was  somewhat 
unusually  susceptible  to  pain.  She  had  always  been  healthy, 
she  said,  with  the  exception  of  having  every  year  a  sore  throat. 

According  to  her  story  and  various  inquiries  she  was  capable 
enough  in  all  places  that  she  undertook  to  fill  but  lost  them 


268  THE    KINGDOM    OF    EVILS 

through  alcohoHsm  and  the  morphine  habit  which  she  had 
acquired  very  shortly  after  beginning  to  drink.  She  was  a 
rather  winning  sort  of  person  and  very  successful  in  getting 
help  for  herself  by  various  subterfuges.  Thus  she  had  the 
usual  skill  in  getting  morphine  by  surreptitious  routes  and 
she  could,  on  occasion,  obtain  help  in  getting  out  of  hospitals 
or  institutions.  At  one  of  these  institutions  she  had  been 
destructive  and  quite  unmanageable.  She  told  at  the  hospital 
a  very  striking  story  about  seeing  a  girl  friend  murdered  by 
a  certain  doctor  who,  as  she  said,  had  great  influence  over  her 
own  life  and  with  whom  she  had  had  sex  relations.  This  story 
remains  quite  unverified  and  is,  no  doubt,  an  example  of  the 
fantastic  lying  which  not  only  morphine  patients  are  apt  to 
indulge  in  but  which  is  likely  to  be  shown  by  sundry  psycho- 
pathic personalities  without  the  influence  of  morphine. 

She  came  to  the  hospital  technically  "left  by  herself"  but 
was,  as  a  matter  of  fact,  brought  in  in  a  disheveled  state  by  a 
man  and  a  woman.  The  man  had  found  her  somewhere  drunk 
and  had  brought  her  in  an  automobile  to  the  hospital,  where 
she  had  told  the  man  she  wished  to  come.  She  was  quite  inco- 
ordinated,  excited,  and  restive  and  apparently  was  hallucinat- 
ing. (She  said:  "Oh,  how  it  stares  me  in  the  face.  If  he  had 
only  killed  me  instead  of  her.")  It  remains,  we  suppose,  a 
question  whether  she  was  actually  a  victim  of  false  perceptions 
or  whether  she  was  embroidering  after  the  manner  of  the 
morphinist  or  psychopathic  liar. 

The  diagnostic  question  at  once  arises  whether  Marian  was 
not  feeble-minded.  The  term  feeble-mindedness  can,  as  has 
been  constantly  shown  above,  be  used  in  various  ways  and 
some  authors  speak  of  a  pure  defect  of  will  and  emotions  (the 
so-called  amoralia  of  authors  in  which  intelligence  is  entirely 
preserved  or  at  a  normal  level)  as  feeble-mindedness.  This 
use  of  the  term  feeble-mindedness  would,  then,  have  reference 
to  social  rather  than  demonstrable  psychical  defect.  The  im- 
pression of  certain  psychiatrists  who  saw  her  when  she  first 
went  to  the  hospital  for  the  insane  was  that  she  was  a  feeble- 
minded person  but  at  that  time  no  special  tests  were  made. 
When  these  tests  were  performed  she  was  found  to  be  some- 
what deteriorated,  but  the  detail  of  the  tests  seemed  to  indicate 
that  she  was  really  not  fundamentally  feeble-minded.  As  we 
insist  elsewhere,  the  things  Marian  did  that  brought  her  to 


THE    KINGDOM    OF    EVILS  269 

social  attention  would  not  be  explained  by  a  low  intelligence 
rating  even  had  she  shown  such  demonstrable  defect  outside 
the  zone  of  will  and  emotion.  Put  briefly,  the  psychopathic 
personality  may  be  feeble-minded  to  test  or  may  test  out  not 
at  all  feeble-minded ;  the  psychotic  trends  remain  somewhat  in- 
dependent of  the  intellectual  level,  though  no  doubt  the  patient's 
degree  of  responsibility  must  hang  somewhat  upon  her  intel- 
lectual powers  of  judgment. 

This  case  might  be  counted  as  a  social-service  failure.  No 
doubt  the  social  worker  will,  until  the  end  of  time,  have  cer- 
tain failures  to  score.  Supervision  has  failed  to  reform  Marian 
despite  her  capabilities  in  the  line  of  work  and  despite  a  high 
"empathic  index"  or  attractiveness  which  means  that  she  will, 
no  doubt,  always  have  friends.  Unfortunately  she  makes 
friends  amongst  other  psychopaths.  The  well-known  gregari- 
ousness  of  morphinists  may  play  a  part  here  and  this 
gregariousness  of  drug  addicts  has  always  to  be  borne  in  the 
social  worker's  mind.  How  much  this  gregariousness  is  a 
matter  of  morphinism  or  heroinism  and  how  much  it  is  a  mat- 
ter of  a  certain  mild  integrating  psychopathic  trend  must  be 
left  to  the  future  to  decide. 

Marian  Spring  will  be  what  the  English  call  an  "in  and  out" 
for  many  years.  Such  forces  as  national  prohibition  and  an 
effective  Harrison  law  and  other  devices  for  the  successful 
removal  of  alcohol  and  drugs  from  her  habitat  will,  perhaps,  in 
the  end,  leave  her  a  not  very  socially  dangerous  character. 

Hours  spent  by  Medical  record,  ^,2  pages 

Social  record,  16  pages 
Physician,  6^2  Social  work: 

Visits,  9 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  7 
Social  worker,  20^  Letters,  18 


SECTION  V 

ENCEPHALOPSYCHOSES    ( BRAIN  DISEASE) 

Psychoses  of  old  age.  Prognosis  in  arteriosclerosis.  Sales- 
man with  moments  when  he  "lost  himself."  State  hospital  care 
or  private  measures? 

Case  64.  A  psychiatric  social  worker  always  has  to  con- 
tend with  the  feeling  on  the  part  of  many  physicians,  many 
fellow  social  workers,  and  the  majority  of  laymen  that  mental 
disease  is  incurable.  Even  if  something  by  experience  has 
been  done  to  diminish  this  feeling  for  sundry  types  of  mental 
disease,  the  feeling  of  poor  prognosis  and  of  probable  incura- 
bility still  hangs  about  most  patients  developing  mental  symp- 
toms in  the  fifties,  sixties,  or  seventies.  We  give  two  instances 
later  in  this  book,  those  of  Catherine  Cudahy  (case  69  and 
Jeanette  Burroughs,  case  68),  in  which  psychoses  developing 
in  old  age  were  still  not  inconsistent  with  remarkable  ameliora- 
tion and  easy  accessibility  to  social-service  measures. 

A  very  firmly  fixed  medical  prejudice  is  that  "one  is  as  old 
as  his  arteries."  Accordingly  a  victim  of  the  hardening  of  the 
arteries  (arteriosclerosis)  is  assumed  to  be  by  the  same  token 
a  victim  of  old  age  or  its  equivalent.  Since  old  age  has  uni- 
versally so  poor  a  prognosis,  then  hardening  of  the  arteries  is 
dropped  into  the  same  basket  of  poor  prognoses.  Now,  in 
point  of  fact,  there  are  various  kinds  of  arteriosclerosis,  only 
some  of  which  characterize  old  age,  and  many  forms  of  arterio- 
sclerosis are  not  in  any  respect  characteristically  senile.  One 
of  the  greatest  surprises  of  the  youthful  physician  is  to  see 
cases  of  severe  arteriosclerosis,  looking  to  be  at  the  point  of 
death,  come  around  in  the  course  of  weeks  or  months  to  a 
phase  of  comparative  normality  and  even  capacity  of  self- 
support. 

Thomas  Warren,  sixty-four,  received  the  diagnosis  of 
arteriosclerotic  dementia  at  the  Psychopathic  Hospital,  whence 

270 


THE    KINGDOM    OP    EVILS  2.^1 

he  could  be  discharged  somewhat  improved  after  about  three 
weeks'  observation,  for  the  most  part  as  a  voluntary  patient. 
The  term  "dementia"  has  almost  invariably,  to  a  physician  as 
well  as  to  a  layman,  the  suggestion  of  permanence  and  in- 
curability, although  there  is  nothing  about  the  prefix  de  in  this 
word  dementia  which  necessarily  signifies  that  the  deterioration 
is  either  permanent  or  temporary  (in  fact  some  of  the  older 
psychiatric  textbooks  talk  of  certain  acute  dementias  which 
often  led  to  complete  recovery).  Sometimes  the  term  "deterio- 
ration" is  used  for  milder  degrees  of  "dementia."  Perhaps  it 
would  have  been  safer  to  call  the  case  of  Thomas  Warren 
(with  some  of  the  physicians)  a  case  of  arteriosclerotic 
"psychosis,"  thereby  dodging  the  suggestion  of  permanence 
that  now  sticks  to  the  term  "dementia."  At  all  events,  as  above 
stated,  Thomas  Warren  was  discharged  somewhat  improved. 

Little  is  known  of  Warren's  early  history.  His  father  had 
died  of  a  shock.  Warren  himself  had  worked  as  a  salesman 
and  buyer  from  youth  up  and  had  never  had  any  symptoms  of 
nervous  disease  until  some  six  or  seven  months  before  admis- 
sion, when  a  hemorrhage  of  the  eye  had  occurred  and  he  had 
found  some  difficulty  in  working.  He  kept  at  work,  but  began 
to  lose  his  memory.  At  times  during  this  period  of  six  months 
he  completely  lost  himself  for  a  few  minutes  at  a  time.  He 
made  mistakes  in  his  work  and  knew  that  he  had  to  be  watched 
on  this  account. 

These  spells  of  losing  oneself  are  amongst  the  most  sug- 
gestive features  of  arteriosclerosis  in  men  of  his  age,  especially 
so  when  associated  with  gradual  loss  of  memory  and  other 
signs  of  deterioration.  (The  layman  should  not,  however, 
feel  too  great  assurance  as  to  the  nature  of  such  spells,  since 
epileptic  and  epileptoid  conditions  might  likewise  bring  them 
about.)  It  is  worth  while  to  insist  that  these  "seizures"  are 
not  signs  of  senile  dementia,  but  are  signs  of  either  arterio- 
sclerosis or  some  other  form  of  disease  not  necessarily  senile. 
The  important  point  we  here  try  to  make  is  that  they  do  not 
necessarily  argue  an  invariably  down-grade  process  on  the 
part  of  the  patient.  They  may  very  well  correspond  with  ex- 
ceedingly slight  destructive  processes,  due  to  blood-vessel  dis- 
ease, in  the  brain  and  may  very  well  go  alongside  an  almost 
complete  normality  of  the  whole  brain  mechanism.  Moreover, 
the  progress  of  these  cases   is  not  seldom  highly  irregular. 


272  THE    KINGDOM    OF    EVILS 

Persons  with  very  definite  and  severe  apoplectic  seizures,  in- 
volving the  paralysis  of  an  entire  side,  may  not  only  recover 
to  a  large  extent  the  functions  lost  at  the  time  of  the  so-called 
"stroke,"  but  may  live  to  perform  important  functions  in  life 
and  even  to  carry  on  complex  business  affairs.  In  short,  let  us 
insist  that  no  very  definite  prognosis,  either  of  regular  or 
irregular  down  grade  or  of  improvement  should  be  offered. 
Nevertheless,  it  will  be  in  the  interest  of  the  patient  from  the 
social  standpoint  to  give  him  the  benefit  of  the  doubt  with 
respect  to  his  outcome.  Not  rarely  will  the  worker  be  rewarded 
by  a  very  fair  compensation  in  the  patient's  life  as  a  result  of 
the  execution  of  right  social  measures. 

Warren  was  still  a  rather  well-developed  and  nourished  man, 
with  a  slightly  increased  blood  pressure.  His  gait  was  un- 
steady and  rather  stiff.  There  was  a  certain  incoordination 
also  in  the  movements  of  his  arms,  and  with  eyes  closed  he 
would  fall  to  the  ground.  Both  fingers  and  toes  were  tremu- 
lous at  the  time  of  his  hospital  observation.  He  had  been  rather 
depressed  before  coming  to  the  hospital.  It  would,  of  course, 
seem  natural  to  the  normal  observer  for  a  man  thus  affected 
to  be  depressed,  and  it  might  seem  that  the  depression  was  a 
perfectly  normal  sadness;  yet  depression  and  emotionality  with 
a  tendency  to  rather  disproportionate  weeping  have  been  ob- 
served to  be  symptoms  in  arteriosclerotic  brain  disease.  The 
depression  is  often  much  more  a  symptom  due  to  sundry  stimuli 
working  directly  in  the  tissues  or  from  the  juices  of  the  body 
than  a  rational  effect  of  deliberate  thinking  about  one's  des- 
perate situation. 

It  became  a  question  whether  Warren  should  not  be  sent  to 
a  state  hospital  for  permanent  care,  partly  on  account  of  his 
dementia,  which  might  be  better  cared  for  at  a  hospital  than 
at  home,  and  partly  on  account  of  the  low  state  of  his  savings. 
It  becomes  a  delicate  question  of  some  practical  difficulty 
whether  to  advise  that  such  rather  gradually  deteriorating  per- 
sons shall  remain  in  the  community  or  be  committed  to  a  state 
hospital.  On  the  whole,  in  most  communities  of  a  proper  de- 
gree of  civilization,  the  state  hospital  will  prove  to  offer  better 
facilities  at  a  less  total  cost  to  all  concerned  than  private  meas- 
ures can  readily  equal.  It  is  of  course  possible  with  these  cases, 
as  with  almost  all  others,  to  construct  an  "institutional  equiva- 
lent" by  turning  some  home  into  a  hospital.     Some  years  ago 


THE    KINGDOM    OF    EVILS  2/3 

public  authorities  upon  the  insane  used  to  bring  up  the  question 
whether  the  state  might  not  soon  be  asked  to  take  care  of  many 
persons  who  could  as  readily  exist  outside  the  institutions.  If 
we  look  at  the  subject  from  the  standpoint  of  the  total  cost  to 
the  community,  regardless  of  its  exact  and  temporary  source, 
we  shall  probably  be  compelled  to  agree  that  on  the  whole  the 
modern  trend  toward  state  hospital  care  of  persons  hard  to 
manage  outside  is  the  right  trend  and  one  to  encourage.  On 
the  whole,  there  is  an  invisible,  but  none  the  less  actual,  insur- 
ance in  the  community,  through  the  processes  of  state  care, 
over  against  all  manner  of  friction,  wasted  time,  energy,  and 
money  spent  by  inexpert  relatives  of  mentally  sick  persons.  As 
the  almshouse  stigma  disappears  from  state  hospitals,  as  the 
insanity  stigma  diminishes  to  a  hardly  visible  point,  the  trend 
toward  state  care  of  unfortunates  of  this  group  will  no  doubt 
become  stronger  still.  Sentiment  will  turn  into  sentiment  for, 
instead  of  sentiment  against,  state  care. 

Hours  spent  by  Medical  record,  19  pages 

Social  record,   11   pages 
Physician,  8^  Social  work: 

Visits,  10 
Psychologist,  o  Interviews  at  hospital,  8 

Telephone  calls,  14 
Social  worker,  23  Letters,  4 


Chordc  girl  with  illegitimate  child.  Outbursts  of  temper; 
lying.  Improvement  in  maternity  home.  Persistent  social 
problem. 

Case  65.  Though  from  the  psychiatric  side  Helen  Fitz- 
patrick  gave  somewhat  the  effect  of  a  psychopathic  personality, 
she  was  a  victim  of  chorea.  Her  mental  symptoms  accordingly 
gave  rise  to  the  question  whether  she  was  not  what  psychiat- 
rists call  a  "symptomatic"  psychosis.  These  "symptomatic" 
mental  diseases  appear  incidentally  in  the  midst  of  other  well- 
recognized  diseases  of  a  somatic  nature,  for  example,  typhoid 
fever  or  pneumonia.  Chorea,  in  the  form  in  which  Helen 
Fitzpatrick  showed  it,  is  itself  probably  an  infectious  disease, 


274  THE    KINGDOM    OF    EVILS 

Looking  at  the  Fitzpatrick  girl  from  the  side  of  social 
factors,  we  find  the  following  list: — 

Stealing 
Lying 

Sex  delinquency 
Outbursts  of  temper 
Industrial  disability 
Family  discord 
Separation  from  family 
Lack  of  early  training 
Insufficient  income 

The  major  social  diagnosis  was  set  down  as  delinquency. 

Upon  her  admission  to  the  Psychopathic  Hospital  Helen  re- 
marked, "We  are  all  a  high-strung  bunch,  the  whole  of  us  at 
home,  and  that  is  all  the  trouble.  We  get  on  each  other's 
nerves."  It  seems  that,  a  fortnight  before,  a  probation  officer 
was  called  in  by  Helen's  father,  because  she  had  cut  up  her 
sister's  hair  ribbon  and  thrown  flatirons  about.  Her  choreic 
movements  were  very  marked  while  she  was  in  the  receiving 
ward.  She  explained  she  was  untidy  in  dress  because  she  had 
been  taken  from  her  house  at  five  o'clock  in  the  morning.  In 
point  of  fact  she  had  refused  to  dress  at  all. 

Physically  she  was  found  to  have,  besides  choreic  movements, 
slight  heart  trouble  (often  found  in  choreics).  All  the  re- 
flexes were  very  active.  Mentally  she  was  quite  inaccessible 
to  the  examiner,  although  she  was  plainly  oriented  in  every 
way  and  very  emotional.  Later  she  grew  more  accessible  and 
rated  by  psychological  tests  pretty  evenly  at  fifteen  (she  rated 
at  good  or  very  good  in  the  supplementary  tests,  except  in  those 
for  motor  coordination  wherein  she  was  fair  and  in  those  for 
voluntary  attention  where  she  was  poor).  While  in  the  hos- 
pital she  grew  quieter  and  the  chorea  was  even  somewhat 
lessened. 

The  court,  on  representation  that  supervision  for  Helen 
should  be  undertaken,  readily  accepted  the  offer  of  supervision 
for  Helen  by  our  social  service.  After  a  few  weeks  in  a  con- 
valescent home,  where  it  was  determined  that  she  had  become 
pregnant,  she  was  sent  to  a  maternity  home  and  remained  until 
after  the  birth  of  her  baby  three  months  later.  She  Improved 
in  health  and  recovered  from  the  chorea.  Her  mental  attitude 
improved  and  she  took  a  mature  and  sensible  view  of  her  situa- 


THE    KINGDOM    OF    EVILS  275 

tion.  She  was  brighter  than  most  girls  in  the  home.  She 
showed  no  conduct  irregularities  or  signs  of  bad  temper  while 
there. 

Her  marriage  with  the  child's  father,  a  boy,  Thomas  Lynch, 
was  seriously  considered.  In  the  beginning  her  father  insisted 
that  they  should  be  married,  but,  as  the  shiftlessness  of  Lynch 
and  the  rather  low  standard  of  his  family  came  to  light,  Helen's 
parents  became  persuaded  that  the  marriage  would  be  an  addi- 
tional misfortune.  Lynch  was  willing  to  marry,  but  left  the 
decision  to  his  mother.  Mrs.  Lynch  objected  to  having  her  son 
"tied  for  life  to  a  girl  like  Helen."  As  the  boy  was  under  age, 
his  mother's  consent  was  necessary,  and  in  the  end  she  flatly 
refused  to  give  it,  although  she  did  agree  that  Thomas  should 
support  the  baby.  The  final  conclusion  of  all  concerned  was 
that  a  marriage  between  the  two  would  lead  only  to  further 
unhappiness.  The  priest  cooperated  by  advising  against  the 
marriage. 

When  Helen  was  ready  to  leave  the  maternity  home,  she 
was  referred  to  a  children's  agency  with  the  understanding 
that  she  and  her  baby  should  be  boarded  in  a  family  where 
Helen  might  be  trained  in  the  care  of  the  child.  She  was  fond 
of  the  baby  and  proud  of  her.  Her  attitude  in  general  was 
so  much  improved  that  she  was  allowed  instead  to  go  home, 
but,  though  she  took  good  care  of  her  baby,  she  shirked  all 
other  responsibilities  and  got  on  so  poorly  at  home  that  she 
was  sent  to  board  with  the  baby  in  a  country  home.  The  baby 
after  being  weaned  was  boarded  separately,  and  Helen  was 
placed  in  another  family  to  do  housework.  This  she  did  not  at 
all  like,  and  she  proved  unsatisfactory  to  her  employer  because 
she  was  untruthful  and  untidy.  After  three  months  she  was 
allowed  to  go  to  a  relative,  who  conducted  a  small  sanatorium 
and  who  undertook  to  be  responsible  for  her.  Mrs.  Fitzpatrick 
took  the  baby  home. 

Here  then  is  a  case  which  promises  to  be  a  persistent  and 
year-long  problem. 

Hours  spent  by  Medical  record,  21  pages 

Social  record,  20  pages 
Physician,  3^  Social  work: 

Visits,  2.2 
Psychologist,    l  Interviews  at  hospital,  6 

Telephone  calls,  10 
Social  worker,  34  Letters,  18 


SECTION  VI 

SOMATOPSYCHOSES     ( BODILY    DISEASE) 

Mother  of  illegitimate  child,  with  dubious  mild  psychosis. 

Case  66.  Ethel  Murphy,  twenty-seven,  had  been  somewhat 
depressed,  or  at  all  events  sad,  since  having  an  illegitimate  child 
two  months  before  admission.  Her  eyes  were  somewhat  promi- 
nent, her  thyroid  gland  was  enlarged,  her  pulse  was  rapid. 
She  thus  presented  many  of  the  features  of  a  Graves'  disease 
which  was,  however,  of  mild  degree.  She  had  never  expressed 
any  suicidal  ideas.  It  was  suspected  that  at  one  time  she  had 
had  auditory  hallucinations. 

The  social  worker  at  the  hospital  where  she  was  confined 
brought  her  to  the  Psychopathic  Hospital  on  the  ground  that 
as  the  baby  was  to  be  adopted  it  was  important  to  have  the 
mother  examined  for  her  mentality,  so  as  to  reassure  the  foster 
mother. 

The  psychologists  found  that  Ethel  graded  very  irregularly 
at  II. 3  years.  She  cooperated  very  well  but  she  made  several 
illogical  errors  in  the  picture  puzzle  test.  The  irregularity 
(see  discussion  under  case  19)  presumably  signifies  an  ac- 
quired psychosis  rather  than  an  original  subnormality,  but 
there  is  really  no  evidence  of  a  definite  psychosis  unless  we 
are  to  think  of  her  as  a  victim  of  a  slight  or  minor  psychosis 
due  to  hyperthyroidism.  Various  diagnoses  suggested  were 
subnormality  of  mind,  hyperthyroidism,  epilepsy,  and  exhaus- 
tion, but  the  psychological  examination  appears  to  dispose  of 
the  subnormality  of  mind,  at  least  as  a  fundamental  and  origi- 
nal state.  There  was  no  good  evidence  of  epilepsy.  The  re- 
maining suggestions  of  hyperthyroidism  and  exhaustion  place 
her  in  an  undefined  group  of  mental  diseases  due  to  bodily  dis- 
ease. (See  remarks  under  the  case  of  Helen  Fitzpatrick,  case 
65.)  The  child  was,  at  the  suggestion  of  the  physician,  placed 
under  state  care  and  separated  from  the  mother, 

27O 


THE    KINGDOM    OF    EVILS  277 

The  case  was  followed  by  the  social  service  and  Ethel  is 

now  at  work  in  a  contented  frame  of  mind.  That  the  social 
service  had  positively  something  to  do  with  this  result  cannot 
be  contended;  although  only  the  usual  technique  of  counsel  and 
assurance  was  followed.  The  earlier  difficulties  of  technique 
had  centered  about  getting  this  girl,  who  was  (in  her  own 
judgment)  only  slightly  ill  to  take  the  step  of  going  into  the 
wards  of  the  Psychopathic  Hospital  from  the  out-patient  de- 
partment from  which  she  had  been  first  referred.  Xo  doubt 
the  advance  of  psychiatry  in  the  far  future  will  bring  more 
and  more  of  these  exceedingly  dubious  and  (from  the  ordinary 
medical  viewpoint)  extremely  mild  cases  under  early  suitable 
observation. 

Hours  spent  by  ^.ledical  record,  25  pages 

Social  record,  9  pages 
Physician,  5  Social  work: 

Visits,  20 
Psychologist,   i  Interviews  at  hospital,  4 

Telephone  calls,  9 
Social  worker,  34V2  Letters,  16 


Attack  of  mental  disease  follozi'ing  influenza. 

Case  67.  Joseph  O'Brien  is  an  example  of  influenza  psy- 
chosis incidental  to  the  influenza  epidemic  in  Boston  in  191 8. 
He  was  a  case  of  toxic  delirium.  His  mental  symptoms  de- 
veloped in  the  period  of  defervescence,  in  fact  seven  days  after 
the  temperature  fell.  It  seems  that  his  mind  became  affected 
immediately  thereafter.  He  wanted  to  wander  about,  thought 
he  was  on  board  ship,  did  not  recognize  his  family  and  had 
to  be  restrained  by  his  relatives,  would  fall  down,  once  set 
fire  to  a  bureau.  He  himself  said  that  he  had  been  taking  a 
good  deal  of  alcohol  but  this  was  denied  by  his  relatives. 

Upon  admission  he  seemed  to  be  confused  and  was  probably 
hallucinated  as  he  reached  out  his  hands  to  grasp  imaginary 
objects,  apparently  looked  at  the  object,  and  then  began  pick- 
ing at  the  mattress.  His  hands  were  tremulous.  He  remained 
in  the  hospital  four  days  short  of  two  months  and  was  dis- 
charged in  greatly  improved  physical  condition.  His  periods 
of  confusion  kept  recurring  for  three  weeks  after  admission 


278  THE    KINGDOM    OF    EVILS 

and  he  developed  from  time  to  time  a  temperature  which 
reached  103  degrees  on  the  fourth  and  fifth  days  after  admis- 
sion. For  the  rest,  the  physical  examination  proved  negative. 
The  task  of  the  social  service  is  here  simple.  It  is  a  ques- 
tion of  follow-iip.  The  return  of  symptoms  in  influenza  psy- 
chosis is  naturally  a  matter  of  research  at  the  present  time. 
Letters  are  from  time  to  time  received  from  O'Brien  showing 
that  he  is  getting  on  well  and,  in  fact,  "could  not  be  any  better." 

Hours  spent  by  Medical  record,  11  pages 

Social  record,  o 
Physician,  5^  Social  work: 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  I 

Telephone  calls,  o 
Social  worker,  i  Letters,  4 


SECTION  VII 

GERIOPSYCHOSES     (OLD    AGE) 

Senile  psychosis.  Widow  sazv  her  son  zvho  had  been  dead 
forty  years.    Improvement:  proper  care  arranged. 

Case  68.  Jeanette  Burroughs,  a  widow  of  seventy-two, 
was  found  getting  her  meals  on  a  gas  heater  and  doing  needle- 
work for  an  art  society,  with  her  son  paying  the  board  bill. 
She  went  to  church  and  to  the  movies  and  called  upon  her 
friends  from  time  to  time.  She  entered  the  wards  of  the 
Psychopathic  Hospital  from  the  out-patient  department.  She 
had  had  dizzy  spells  for  two  or  three  years,  though  she  had 
never  fallen  down.  Sometimes  she  had  a  peculiar  feeling  in 
her  head  like  rushing  water.  She  was  in  many  respects  very 
well  preserved,  looking  younger  than  her  age.  She  had  at  one 
time  been  treated  for  diabetes.  Just  before  coming  to  the  out- 
patient department,  she  had  imagined  that  a  son,  now  forty 
years  dead,  had  sat  beside  her  and  talked  to  her.  A  man  in 
black  had  walked  up  and  down  in  front  of  her  house.  She 
felt,  she  said,  prostrated  with  grief,  and  her  sleep  had  become 
disturbed  and  fitful.  She  was  a  voluntary  patient  at  the  hos- 
pital, but  there  could  be  no  doubt  that  she  was  legally  com- 
mittable  on  the  score  of  the  clear  hallucinations  and  delusions. 

Physically  she  was  well  developed  and  nourished.  There 
were  no  obvious  lesions  of  the  heart  and  lungs,  and  there  was 
no  special  disturbance  of  blood  pressure.  There  were  no  evi- 
dences in  the  neuromuscular  examination  that  there  had  ever 
been  any  degree  of  destructive  brain  disease.  A  certain  emo- 
tionality and  a  feeling  of  loss  of  memory  were  the  most  out- 
standing mental  symptoms,  except  the  ideas  revolving  about 
the  resurrection  of  her  dead  son. 

Admitted  April  i6,  191 7,  it  was  not  until  June  i  that  she 
gave  up  her  delusions,  admitting  at  that  time  that,  though  the 
ideas  still  did  "come  up  at  times,"  she  was  now  "able  after 
struggling  always  to  put  them  down."     She  said  she  was  less 

279 


28o  THE    KINGDOM    OF   EVILS 

collected  in  the  evening  than  in  the  morning  and  night,  perhaps 
better  be  spoken  to  earher  rather  than  later  in  the  day. 

The  only  point  concerning  the  discharge  of  Mrs.  Burroughs 
now  lay  in  the  question  whether  she  would  have  proper  care 
on  leaving  the  hospital.  This  became  the  province  of  the  social 
service  to  accomplish.  During  the  period  of  a  year  the  social 
service  was  able  to  keep  her  properly  boarded  out  (with  some 
aid  from  charitable  organizations)  and  saw  to  it  that  she  was 
visited  by  friends  from  time  to  time.  She  resumed  her  habit 
of  attending  church  and  the  movies.  She  fell  and  injured  her 
hip  one  winter's  day — an  accident  which  in  an  old  person  is 
ordinarily  very  dangerous.  The  hip  trouble  proved  to  be  merely 
a  contusion,  and  Mrs.  Burroughs  recovered.  At  the  end  of 
this  time  the  case  could  be  closed  so  far  as  the  Psychopathic 
Hospital  social  service  was  concerned.  She  was  left  under  the 
care  of  a  non-psychiatric  social  agency.  She  has  throughout 
continued  to  make  a  little  money  by  needlework  but  so  far  as 
can  be  seen  must  remain  for  the  rest  of  her  life  somewhat  of  a 
charge. 

Is  Mrs.  Burroughs  mentally  normal?  She  is  at  all  events 
now  not  a  victim  of  any  acute  delusional  psychosis,  whether 
senile  in  causation  or  of  any  other  origin.  Nevertheless  from 
time  to  time  it  appears  that  she  still  sees  her  dead  son,  and  it 
is  probable  that  she  still  bears  inside  some  traces  of  the  former 
psychosis.  However,  if  she  had  never  shown  more  psychop- 
athy than  she  now  shows,  no  doubt,  she  would  never  have 
appeared  on  the  records  of  an  institution  for  mental  diseases. 

Hours  spent  by  Medical  record,  28  pages 

Social  record,  10  pages 
Physician,  8  Social  work: 

Visits,    16 
Psychologist,  o  Interviews  at  hospital,  0 

Telephone  calls,   12 
Social  worker,  21^  Letters,  2 


PRESENILE  PSYCHOSIS 

WOMAN,  55 

February  June 

Unoccupied  Occupied 

No  Pleasures  Friends  Call 

Outbursts  of  Temper  Husband  Told  Why 


Presenile  psychosis.  Scolded  by  the  clock.  Home  life  al- 
tered: improvement. 

Case  69.  Catherine  Cudahy,  fifty-five,  kept  hearing  the 
big  clock  on  the  mantelpiece  ticking  at  her  vindictively.  She 
had  become  violently  enraged  by  this  ticking  at  least  twice  in 
a  period  of  two  months.  At  last  her  husband  had  to  send  her 
to  the  Psychopathic  Hospital.  She  thought  a  Holy  Father 
was  on  the  roof. 

Her  case  was  put  by  the  psychiatrists  in  the  presenile  group 
and  was  called  involutional  psychosis.  They  found  her  a  vic- 
tim of  hallucinations  of  hearing,  but  found  that  her  delusion 
about  the  Holy  Father  was  not  very  definite  or  fixed.  She 
finally  admitted  that  the  ticking  of  the  clock  at  her  was  only 
imaginary.  She  had  not  heard  the  clock  ticking  after  the  ar- 
rival at  the  hospital.  Her  memory  seemed  to  be  poor  for 
details  both  of  recent  and  remote  events,  but  she  could  remem- 
ber excellently  the  main  events  in  her  life.  She  was  physically 
rather  obese  and,  since  an  operation  two  years  before,  had 
not  been  able  to  go  to  church.  She  had  begun  to  feel  tired  all 
the  time  and  had  been  hearing  the  clock  talking  for  about  five 
months.  Mrs.  Cudahy  did  not  use  alcohol  (an  important  nega- 
tive fact  for  the  psychiatrists). 

The  problem  for  the  social  worker  came  upon  her  discharge 
"improved."  She  was  somehow  to  alter  her  home  life;  she 
was  not  to  be  left  alone  so  much  or  spend  so  much  time  unem- 
ployed. These  suggestions  were  carried  out  and  she  was  made 
to  take  daily  exercise  outdoors.  The  relatives  were  persuaded 
to  cooperate.  They  visited  her  and  kept  her  busy.  She  re- 
ported regularly  at  the  out-patient  department  every  fortnight, 
and  the  clock  went  definitively  out  of  her  life. 

Hours  spent  by  Medical  record,  11  pages 

Social  record,  3  pages 
Physician,  '7  Social  work: 

Visits,  3 
Psychologist,  o     ■  Interviews  at  hospital,  6 

..  ..,  r«    w     .  Telephone  calls,  i 

S6cial  worker,  7%  Letters,  5 

283 


SECTION  VIII 

SCHIZOPHRENOSES    (DEMENTIA   PRAECOX) 

Cose  of  dementia  simplex  self-supporting  in  the  community. 
May  look  like  feehle-mindedness.  Training.  Simple  environ- 
ment provided. 

Case  70.  There  is  a  form  of  schizophrenia  (dementia 
praecox)  to  which  the  adjective  simplex  is  added.  In  this  form 
of  the  disease  there  is  a  certain  deterioration  and  dulHng  of 
the  emotional  hfe  which  fails  to  be  accompanied  by  the  vari- 
ous so-called  catatonic  ( formerly  termed  cataleptic)  symptoms 
or  by  the  delusions  which  are  so  frequent  in  most  cases  of 
schizophrenia.  Moreover,  in  these  so-called  simplex  cases  the 
emotional  deterioration  may  itself  be  slight,  and  it  is  commonly 
thought  by  psychiatrists  that  a  great  number  of  these  cases 
of  dementia  simplex  are  found  in  the  community  at  large,  per- 
haps self-supporting  or  nearly  self-supporting,  with  a  history 
of  having  sustained  a  slight  regression  in  their  mental  capacity 
insufficient  to  warrant  or  to  suggest  their  internment  in  any 
hospital  for  the  insane.  It  is,  perhaps,  a  little  difficult  for  the 
layman  and  even  for  some  of  the  old-time  physicians  to  think 
of  cases  of  schizophrenia  (dementia  praecox)  as  "not  insane." 
Until  the  concept  of  mental  disease  tJiat  is  not  (medico-legal) 
insanity  becomes  deeply  imbedded  in  the  lay  mind,  as  well  as 
in  the  minds  of  medical  men  and  social  workers,  we  shall  not 
come  through  with  a  proper  program  of  community  mental 
hygiene. 

Dana  Scott,  an  unmarried  man  of  thirty-seven,  was  brought 
to  the  Psychopathic  Hospital  for  observation.  The  woman 
with  whom  he  boarded  told  of  violent  fits  of  temper  on  Scott's 
part,  during  which  clothing  was  torn  and  furniture  knocked 
to  pieces.  As  a  matter  of  fact,  the  landlady  greatly  overdrew 
the  story  about  Scott,  as  investigation  failed  to  substantiate 
any  destructive  tendencies,  nor  was  the  landlady  herself  a  good 
sort  of  person  to  live  with.     Nevertheless,  with  all  the  smoke 

284 


THE    KINGDOM    OF    EVILS  285 

there  was  some  fire.  It  was  generally  agreed  that  Scott  lacked 
ambition  and  initiative  and  might  perhaps  be  the  victim  of  some 
sort  of  mental  defect.  Had  it  not  been  for  the  landlady's  char- 
acter (an  angel  from  heaven,  it  was  said,  could  not  live  peace- 
ably with  her),  Scott  might  have  remained  in  the  community 
even  to  this  day  without  being  noted  by  any  expert  to  be  psycho- 
pathic. He  had  been  a  rather  queer  child.  It  was  told  of 
him  that  he  took  books  to  the  attic  and  stayed  all  day  with  them, 
omitting  meals.  The  country  neighbors  who  saw  him  daily  did 
not  consider  him  at  all  harmful.  A  nurse  who  brought  him 
to  the  hospital  said  that  he  was  one  of  the  most  willing  and 
obedient  patients  she  had  ever  had. 

Here  then  was  a  man  who  was  plainly  in  some  sense  a  psycho- 
path. Perhaps  by  straining  a  point  he  could  have  been  com- 
mitted to  an  institution.  He  was  in  charge  of  a  guardian  and 
had  some  little  property,  so  that  board  could  be  paid  for  him. 
A  place  in  the  country  was  found  in  the  family  of  a  widow 
and  her  daughter.  Here  Scott  could  help  with  chores  and 
might  perhaps  obtain  some  work  in  the  neighborhood.  Shortly 
letters  were  received  from  Scott  telling  how  much  he  liked  his 
new  home.  The  family  were  well  satisfied  with  him  and 
pleased  at  having  a  permanent  boarder  who  was  so  helpful. 

It  may  be  permissible  to  point  out  that  with  the  old  system, 
under  which  the  public  or  private  charitable  institution  "bor- 
rowed no  trouble,"  the  hospital  work  might  have  ceased  with 
the  diagnosis.  In  point  of  fact  the  social  service  was  at  first 
merely  requested  to  secure  a  history.  Yet,  when  such  history 
was  secured,  perfectly  obvious  and  valuable  social-service  meas- 
ures stood  revealed  as  the  proper  procedure.  In  institutions 
where  psychiatric  social  work  is  carried  out  effectually  this  is 
no  infrequent  event,  namely,  that  the  social  worker,  sent  out 
to  secure  a  few  facts,  comes  back  with  a  series  of  rational 
measures. 

Victims  of  the  so-called  simplex  form  of  schizophrenia  are. 
often  looked  upon,  even  by  physicians,  as  feeble-minded,  nor 
is  it  at  all  possible  in  routine  examinations  always  to  determine 
medically  with  which  condition  one  is  dealing.  The  psycho- 
metric tests,  executed  by  a  properly  grounded  mental  examiner, 
are  sometimes  of  service ;  for  instance,  in  the  case  of  Scott,  the 
Binet  record  stood  at  12  1/5  years,  and  he  was  set  down  as 
beyond  question   not   feeble-minded.     His   deterioration  was 


286  THE   KINGDOM    OF   EVILS 

not  intellectual.  The  mental  impairment  was,  as  it  characteris- 
tically is  in  all  cases  of  schizophrenia,  in  the  field  of  the  emo- 
tions. There  was  a  marked  dulling  of  them.  He  was,  from 
some  points  of  view,  not  at  all  unintellectual ;  was.  for  example, 
a  great  reader  of  books  on  science  and  art,  and  conversed  very 
fairly  on  current  topics.  Although  psychopathic  in  this  par- 
ticular way,  he  had  no  savor  of  feeble-mindedness  and  would 
have  been  quite  above  the  level  of  the  majority  of  the  teach- 
ings, which  are  so  skillfully  carried  out  for  the  feeble-mmded 
in  the  schools  appropriate  for  that  group  of  defectives.  There 
can  be  no  doubt  that  his  life  with  the  widow  and  her  daughter 
upon  a  farm  was  exactly  the  right  fate  for  him.  As  with  the 
psychological  examination,  so  the  physical  and  mental  exami- 
nation by  psychiatrists  at  the  hospital  failed  to  show  any  strik- 
ing deviations  from  normal,  and  the  psychiatric  impression 
of  the  case,  based  upon  the  medical  and  social  history,  was 
accordingly  left  at  the  diagnosis  schizophrenia  (dementia  prae- 
cox)  of  the  simplex  form. 

Of  course  many  cases  of  schizophrenia,  particularly  of  the 
catatonic  group  above  mentioned,  are  not  unlikely  to  become 
suddenly  excited  or  violent;  nor  can  it  be  absolutely  excluded 
from  the  range  of  possibility  that  Scott  may  turn  catatonic 
through  some  sudden  access  of  the  structural  or  functional  dis- 
ease which  underlies  his  symptoms. 

The  layman,  as  well  as  the  physician,  must  have  forced  upon 
his  attention  a  certain  sexuality  in  the  symptoms  of  the  ma- 
jority of  cases  of  schizophrenia  (dementia  praecox)  ;  but  it 
would  be  an  injustice  to  many  examples  of  the  disease  to  think 
of  the  sexuality  as  socially  dangerous.  Whatever  bad  habits 
in  the  sexual  field  and  whatever  bad  table  manners  and  other 
impolitenesses  Scott  might  have  been  guilty  of,  probably  all  of 
these  matters  may  never  fall  within  the  social  danger  zone. 
No  doubt  many  of  these  psychopathically  bad  manners  and  cus- 
toms can  be,  to  a  great  degree,  trained  out  of  patients  of  this 
order  by  proper  methods.  Just  as  it  is  possible  to  train  or  tame 
certain  animals  without  the  employment  of  the  methods  open 
to  a  Socrates  or  a  Plato,  so  it  is  possible  to  get  sundry  effects 
sometimes  termed  recducative  in  cases  of  the  schizophrenic 
group.  Whether  the  training  is  in  all  cases  a  genuine  rationali- 
zation with  the  Socratic  or  Platonic  echo  may  be  doubted. 
However  this  may  be,  the  well-managed  hospital  for  the  chronic 


THE    KINGDOM    OF    EVILS  287 

insane,  harboring  as  it  does  so  many  victims  of  this  disease, 
shortly  becomes  a  very  effective  school  for  schisophrenics.  In 
some  governmental  units,  colonies  for  such  schizophrenics  have 
been  developed,  whose  star  patients  are  not  those  who,  like 
Scott,  are  very  easy  to  deal  with  from  the  outset,  but  patients 
who  have  passed  through  most  violent  and  dangerous  phases 
or  phases  of  extreme  apathy  and  utter  economic  worthless- 
ness,  only  in  the  end  to  be  schooled  into  a  very  fair  efficiency. 
With  respect  to  Dana  Scott,  then,  we  may  perhaps  regard 
the  non-angelic  landlady  as  really  something  of  an  angel  in 
disguise. 

Hours  spent  by  Medical  record,  38  pages 

Social  record,  4  pages 
Physician,  4^^  Social  work: 

Visits,  2 
Psychologist,  i  Interviews  at  hospital,  I 

Telephone  calls,  9 
Social  worker,  5  Letters,  2 


DEMENTIA  PRAECOX 
IN  A  MACHINIST 

January,  ipi6  January,  igiy 

Industrial  Disability  Good  Health 

Unemployment  Regular  Work 

Debts  Out  of  Debt 

Suicidal   Attempts  Cheerful 


Vagrant:  irregular  worker:  alcoholic:  attempted  suicide. 
Men's  Club.  Peculiarities  indulged  at  home.  Steady,  reliable 
zvorkman:  a  compensated  schisophrenic.  Economy  of  social 
care. 

Case  71.  Ralph  Johnson  left  home  at  thirty-one  and  was 
not  heard  of  for  the  next  seven  years.  In  point  of  fact  he  was 
roaming  over  the  country  on  foot,  jumping  freights  and  work- 
ing ofif  and  on  in  railroad  gangs.  Wanderlust  over,  Ralph  got 
back  to  Boston  and  worked  as  an  automobile  repairer  for  the 
next  nine  years  in  six  different  places.  He  then  ceased  to  work 
altogether  for  a  number  of  months.  It  seems  that  he  had  had 
an  infection  in  his  hand  for  some  three  months.  He  felt  "run 
down  and  weak,"  one  night  grew  suddenly  talkative,  said  he 
saw  dead  people,  friends  of  his,  and  cut  an  artery  in  his  wrist 
with  a  razor.  He  had  been  drinking,  and  a  diagnosis  of  alco- 
holic mental  disease  was  made.  There  were  no  sexual  contents 
or  ideas  of  jealousy  in  Johnson,  but  he  did  show  delusions  of 
persecution  (people  were  going  to  kill  him)  and  ideas  of  refer- 
ence (the  people  that  he  saw  outside  of  his  house  seemed  to 
him  to  be  "laying  for  him").  There  were  no  genuine  halluci- 
nations (false  perceptions)  in  any  sensory  field. 

Johnson  was  now  referred  to  the  out-patient  department  and 
when  jogged  by  letter  reported  from  time  to  time.  He  ceased 
to  take  any  alcohol  and  for  the  most  part  felt  "fine,  though 
somewhat  unsettled  in  my  mind  with  thoughts  constantly 
changing."  After  a  few  months  he  came  in  one  day  agitated 
and  weeping,  maintaining  that  "his  left  side  was  dead"  and 
that  he  had  "done  terrible  wrongs  to  several  people" — could 
he  not  be  chloroformed  or  have  his  head  cut  off?  Nobody 
would  hire  such  a  man  as  he  was  and  consequently  he  would 
not  ask  for  a  job. 

However  in  the  course  of  a  few  weeks  he  came  in  again  much 
more  clear-headed  and  alert,  laughing  about  the  death  of  his 
left  side,  etc.  Again  he  complained  of  "lack  of  concentration 
of  his  thoughts"  and  talked  somewhat  ramblingly.  He  was 
fading  away,  having  lost  he  said,  fifty  pounds.     From  time  to 

291 


292  THE    KINGDOM    OF    EVILS 

time  he  reported  rather  regularly  for  the  Men's  Club  and  after 
a  time  became  one  of  the  most  regular  attendants  at  this  Club 
which  he  found  his  only  recreation.  However,  finally  he 
stopped  coming  and,  upon  being  visited,  assumed  a  hostile 
attitude  and  feigned  indifference  to  the  hospital,  its  staff  and 
its  attendants.  He  said  he  had  other  things  to  do  than  to 
attend  a  men's  club. 

The  entire  history,  since  his  first  appearance  at  the  hospital, 
has  occupied  five  years.  There  was,  however,  a  second  appear- 
ance in  the  wards  of  the  Psychopathic  Hospital  some  eleven 
months  after  the  first  admission.  Some  days  before  entrance 
to  the  hospital  he  had  begun  to  cry  out  aloud  at  night.  He 
said  his  mother  was  calling  him.  For  several  days  he  cried  out, 
talking  rather  desperately  at  times  yet  laughing  at  other  times, 
and  told  of  a  feeling  of  electric  currents  over  him.  He  was  a 
readily  committable  case,  telling  the  committing  physician  that 
he  had  heard  God's  voice  and  could  hear  it  in  the  hospital  as 
well  as  at  home. 

The  diagnosis  upon  his  discharge  from  this  second  admis- 
sion stood  at  a  question  of  dementia  praecox,  where  the  diag- 
nosis should,  perhaps,  still  stand.  There  is  no  longer  any  ques- 
tion of  alcoholic  mental  disease,  despite  the  rather  certain  view 
of  the  psychiatrist  at  his  first  admission  that  he  was  a  case  of 
alcoholic  paranoia.  Concerning  the  very  existence  of  any  such 
disease  as  alcoholic  paranoia  psychiatrists  have  registered 
doubts,  and  it  can  readily  be  seen  that  a  commixture  of  schizo- 
phrenic symptoms  and  alcoholic  traits  can  easily  confuse  the 
issue;  many  psychiatrists  hold  that  the  only  true  form  of  men- 
tal disease  of  delusional  nature  produced  by  alcohol  is  the  so- 
called  jealousy-psychosis,  an  example  of  which,  from  the  social 
point  of  view,  is  given  in  this  book  under  the  case  of  Michael 
Piso  (case  62). 

Johnson  remained  in  the  hospital  four  months  after  this 
second  admission.  On  his  discharge  he  went  to  work  once 
again  in  an  automobile  repair  shop.  They  said  he  was  a  good, 
handy  man  at  this  work,  although  he  worked  somewhat  slowly 
and  if  at  all  hurried  got  nervous  and  tired.  He  had  to  be  laid 
off  once  when  work  was  slack.  He  readily  got  another  position 
at  eighteen  dollars.  They  said  he  was  a  very  steady  and  reli- 
able workman.  Once  he  had  a  petty  argument  with  his  fore- 
man and  lost  his  job.    Immediately  he  secured  another  job,  this 


THE    KINGDOM    OF   EVILS  293 

time  at  twenty-five  dollars  a  week.  Johnson's  home  was  on 
a  fairly  high  economic  level.  He  lived  with  his  sister.  She 
had  to  be  instructed  concerning  the  indulgence  of  eccentricities 
on  Johnson's  part.  She  learned  not  to  irritate  him  overmuch 
and  was  got  to  manage  him  with  exceeding  intelligence. 

Is  this  a  case  of  schizophrenia  (dementia  praecox)  ?  It  is, 
at  all  events,  a  case  with  definite  psychopathic  phases  and  prob- 
ably belongs  somewhere  in  the  general  group  of  the  schizo- 
phrenics. Yet  we  may  think  of  Johnson  as  in  some  sense  a 
compensated  schizophrenic.  Perhaps  no  one  would  regard 
him  as  entirely  normal,  though  it  would  certainly  stump  the 
ordinary  observer  to  pick  anything  psychopathic  out  of  his 
behavior  for  days  and  weeks  at  a  time.  There  seems  to  be  no 
question  whatever  that  the  social  service  here  aided  and  abetted 
the  process  of  character  compensation.  Again,  we  may  not 
unduly  insist  that  the  ordinary  method  of  letting  such  cases 
go  adrift  in  the  community  without  supervision  and  follow-up 
is,  in  the  long  run,  a  much  more  expensive  process  to  the  com- 
munity than  the  cost  of  proper  medical  and  social  care  and 
supervision  (to  say  nothing  of  the  effects  of  a  non-compen- 
sated schizophrenic  in  the  matter  of  possible  violence,  and 
disturbance  of  the  peace).  There  was  also  to  consider  the  alco- 
holism, to  which  this  wanderer  had  fallen  victim  when  he  first 
came  to  observation  at  the  age  of  forty-eight.  How  many 
of  the  wanderers  on  the  countryside  and  persons  found  jump- 
ing freights  may  really  be  schizophrenic  is  a  statistical  ques- 
tion whose  answer  might  vary  in  different  communities  and 
countries.  Whether  the  tally  reaches  fifty  per  cent  may  be 
questioned.  A  good  many  epileptics,  manic-depressive  psy- 
chotics,  and  psychoneurotics  may  also  be  found  amongst  the 
hoboes  to  say  nothing  of  queer  characters  whose  abnormalities 
are  of  a  milder  and  not  easily  classified  form.  (There  is  even 
a  group  of  so-called  victims  of  poriomania  that  seem  to  repre- 
sent a  specially  developed  instinct  of  wandering.) 

Hours  spent  by  Medical  record,  11  pages 

Social  record,  18  pages 
Physician,  7^  Social  work: 

Visits,  7 
Psychologist,  o  Interviews  at  hospital,  12 

Telephone  calls,  7 
Social  worker,  27  Letters,  5 


294  THE    KINGDOM    OF    EVILS 

Litigious  vagrant:  counterfeiter.  Case  of  paraphrenia  sys- 
tematica. 

Case  72.  Manual  Rizzo  is,  no  doubt,  a  victim  of  so-called 
paraphrenia  systematica,  a  new  name  now  rather  frequently 
used  for  the  so-called  delire  chronique  a  evolution  systematiqiie 
of  the  French  psychiatrist  Magnan.  Although  the  task  of  the 
social  service  here  was  more  contributory  to  diagnosis  than 
to  treatment  or  care,  the  Rizzo  case  is  presented  because  the 
social  worker  ought  to  have  in  mind  some  general  picture  of 
this  condition. 

Born  in  the  Azores,  Rizzo  had  come  to  this  country  at  seven- 
teen and  was  now  sixty  years  of  age.  For  some  seven  years 
he  had  been  a  vagrant.  He  was  of  a  rather  villainous  appear- 
ance on  account  of  a  turning  out  of  his  reddened  eyelids.  He 
was  in  general  docile  and  affable  but  would  now  and  then  flare 
up.  In  the  admission  ofifice  he  said  he  thought  the  officer  who 
arrested  him  had  it  in  for  him.  In  fact  that  same  officer  had 
arrested  him  seven  years  before.  He  was  very  circumstantial 
in  his  talk  and  gave  the  impression  that  he  felt  he  was  a  rather 
important  personage.  He  said  he  was  quite  able  to  supp9rt 
himself.  He  told  circumstantially  about  his  trip  from  the 
Azores  and  the  various  jobs  which  he  had  held.  According 
to  his  own  story  his  trouble  had  begun  in  his  forty-eighth  year 
over  some  trade  dollars  which  he  exchanged  for  legal  dollars. 
He  said  that  ever  since  he  had  had  a  lawsuit  over  these  dollars 
with  the  United  States  Government.  He  had  studied  law  and 
was  now  able  to  handle  his  cases  perfectly  well.  He  said  he 
was  a  strong  temperance  man  and  gave  a  long  harangue  on 
temperance.  He  explained  his  not  working  for  seven  years 
on  the  ground  that  he  had  been  too  busy  looking  after  his  affairs 
in  court.  He  said  he  did  a  little  work  now  and  then  and  lived 
on  it.  However,  he  did  not  live  very  well  for  he  was  alive  with 
vermin.  Upon  inquiry  at  the  courthouse  it  was  found  that 
there  were  actually  docket  entries  of  nine  cases.  He  had  lost 
all  of  these  cases  except  one.  It  appeared  that  he  came  to 
court  daily  when  not  in  jail  and  went  to  file  a  suit  against  some- 
one every  time  he  had  the  necessary  three  hundred  dollars. 
As  for  the  jail,  it  was  found  that  he  had  been  sent  to  jail  at 
least  twelve  times  for  vagrancy.  Apparently  he  had  once  had  a 
small  tailor  shop  and  a  man  was  found  who  had  known  him 


THE    KINGDOM    OF    EVILS  295 

for  some  twenty-five  years  and  knew  him  as  "queer  but  harm- 
less." It  appears  that  in  those  early  days  he  had  been  very 
religious.  He  had  gone  to  church  daily,  sometimes  had  gone 
up  to  the  altar  and  followed  the  priest  about  imitating  every- 
thing he  did  toward  the  celebration  of  the  mass.  He  bored 
holes  in  silver  coins  and  plugged  the  holes  with  other  material. 
Of  recent  years  he  had  been  seen  getting  food  from  garbage 
pails.  He  was  also  much  of  a  collector,  keeping  pieces  of 
paper  and  other  objects  that  he  happened  to  find  in  ash  cans. 
He  had  served  three  prison  sentences  for  counterfeiting. 

The  emotions  and  the  will  in  the  paraphrenic  are  theoretically 
supposed  to  be  normal  or  to  suit  the  nature  of  the  ideas  enter- 
tained. Rizzo  would  grow  irritable  at  times,  particularly  when 
telling  of  his  troubles,  but  this  irritability  was  a  very  super- 
ficial one  and  soon  disappeared.  He  assumed  rather  an  ora- 
torical attitude  when  speech-making  but  here  again  the  action 
suited  the  idea  and  there  could  be  no  question  of  a  primary 
disorder  of  the  will.  The  imitation  of  the  priest  at  mass  may 
very  possibly  be  so  regarded ;  yet  on  the  whole,  we  are  better 
entitled  to  regard  this  old  habit  as  a  sign  of  his  belief,  even 
at  that  time,  in  his  being  a  good  deal  of  a  personage. 

Hours  spent  by  Medical  record,  14  pages 

Social  record,  3  pages 
Physician,  5^  Social  work: 

Visits,  3 
Psychologist,  0  Interviews  at  hospital,  o 

Telephone  calls,   i 
Social  worker,  4  Letters,  o 


Diagnosis  between  schizophrenia  and  cyclothymia.  Skilled 
salesman  who  lost  his  position  through  peculiar  behavior.  Re- 
covered: remained  steady:  works  regularly. 

Case  73.  It  is  an  open  secret  that  it  is  not  an  easy  psy- 
chiatric distinction  to  draw  in  every  case  between  schizophrenia 
(dementia  praecox)  and  cyclothymia  (manic-depressive  psy- 
chosis). The  two  diseases  are  paired  in  the  psychiatrist's  mind 
as  sister  diseases,  the  former  rather  more  frequent  than  the 
latter,  both  in  the  number  of  first  cases  developing  and  in  the 
number  remaining  in  state  hospitals  under  observation.    When 


296  THE    KINGDOM    OF    EVILS 

the  diagnosis  lies  between  schizophrenia  and  cyclothymia,  ap- 
parently the  psychiatrist  is  statistically  somewhat  more  likely 
to  be  right  if  he  decides  upon  schizophrenia.  It  should  be  in- 
sisted that  psychiatrists  chiefly  familiar  with  chronic  institu- 
tional material  are  somewhat  more  likely  to  take  a  pessimistic 
view  of  the  prognosis  of  mental  disease  in  general  than  are  the 
consulting  neurologists  of  out-patient  departments  or  of  special 
practice  or  the  specialists  in  charge  of  sanatoriums.  In  the  ten- 
day  period  of  observation  which  the  law  tends  to  procure  for 
the  majority  of  cases  at  the  Psychopathic  Hospital  in  Boston, 
there  will,  perhaps,  be  an  error  in  diagnosis  between  these  two 
diseases  of  something  like  fifteen  or  twenty  per  cent ;  sometimes 
the  error  will  be  upon  one  side,  sometimes  upon  the  other. 

The  present  case  of  Paul  Ernst  is  not  the  first  in  this  book 
in  which  doubt  has  reigned  concerning  the  diagnosis  schizo- 
phrenia as  against  some  other  form  of  mental  disease.  At 
least  three  diagnoses,  psychiatrically  speaking,  have  been  offered 
for  Paul  Ernst :  namely,  alcoholic  hallucinosis,  dementia  prae- 
cox,  and  manic-depressive  psychosis. 

Ernst  has  been  a  patient  twice  at  the  Psychopathic  Hospital, 
once  in  191 3  and  again  in  1914-15.  At  the  first  admission  there 
seemed  no  doubt  at  all  of  the  diagnosis  of  dementia  praecox. 
He  had  run  about  his  house  nude,  broken  up  furniture,  and 
attacked  members  of  the  household.  He  refused  to  talk  and 
became  very  sullen  and  obstinate.  Just  before  this  he  had 
begun  to  worry  over  business  matters  and  had  grown  morbidly 
depressed  when  an  advance  in  salary  was  refused.  One  Satur- 
day night  he  had  been  quite  broken  up  and  discouraged  and 
unable  to  sleep.  Sunday  he  had  been  normal,  but  Monday 
grew  wildly  excited.  His  excitement  had  lasted  twenty-four 
hours. 

In  the  hospital  he  became  very  violent,  at  times  requiring 
seven  or  eight  attendants  to  put  him  in  the  wet  pack.  He 
shouted,  screamed,  swore,  and  cried  out,  talking  either  sarcas- 
tically or  very  angrily  about  his  treatment.  During  inactive 
periods  he  assumed  a  disagreeably  sullen  manner.  He  remained 
for  the  most  part  quiet,  inaccessible  to  the  examiners,  but 
evincing  some  flight  of  ideas  in  his  talk. 

He  was  committed  to  the  Boston  State  Hospital  where  he 
remained  a  month  but  was  discharged  with  the  diagnosis  manic- 
depressive  psychosis.     He  became  entirely  clear  in  his  mind 


THE    KINGDOM    OF    EVILS  297 

before  discharge.  He  now  went  back  to  his  work  as  a  sales- 
man of  a  special  kind  of  goods.  He  had  never  been  alcoholic, 
so  that  the  initial  suggestion  of  alcoholic  hallucinosis  was 
unfounded. 

After  a  time  he  began  again  to  worry  about  finances.  One 
day  at  the  department  store  where  he  worked,  he  began  to  act 
peculiarly  and  left  for  home.  There  he  smashed  windows  and 
brought  down  a  chandelier.  He  was  again  brought  to  the 
Psychopathic  Hospital  and  was  there  acutely  maniacal  for 
some  three  days,  but  after  this  interval  a  physical  examination 
became  possible,  and  he  was  found  to  be  practically  negative 
in  all  respects.  Mentally  he  was  suspicious,  rather  facetious, 
and  non-cooperative  upon  admission  but  obviously  perfectly 
oriented  for  time  and  place.  He  tore  blankets  and  night  shirt, 
was  profane,  obscene,  and  noisy  and  was  treated  by  the  pro- 
longed baths  and  by  packs.  He  either  was  not,  or  assumed  not 
to  be,  interested  in  his  surroundings,  kept  his  eyes  staring 
wide  open,  and  winked  constantly.  He  lay  in  bed  in  a  rather 
strained  position.  For  a  while  on  the  first  day  he  stood  in 
front  of  a  window,  talking,  but  there  was  a  large  question 
whether  the  behavior  was  in  response  to  hallucinations.  The 
psychiatric  reader  will  note  how  difficult  a  diagnosis  must  be 
with  such  phenomena  between  schizophrenia  and  cyclothymia. 

On  about  the  seventh  day  there  was  a  change  of  phase :  he 
now  appeared  confused,  was  quiet  but  restive,  and  threw  him- 
self from  the  bed  a  number  of  times.  He  would  burst  into 
noises  now  and  then,  but  was  at  other  times  apparently  quite 
rational.  Things  going  on  about  him  he  took  in  quickly  and 
was  rather  mischievous  in  his  remarks  and  actions.  He  began 
to  speak  of  his  wife  and  family  and  talked  about  wanting  to 
go  home.  At  the  end  of  three  weeks  from  his  admission,  it 
was  possible  to  send  him  home  in  a  clear  state  of  mind.  He 
thought  that  he  really  had  heard  false  voices  just  after  admis- 
sion, but  conceived  that  they  might  possibly  be  the  talking  of 
the  attendants  misinterpreted  by  him.  He  had  however  once 
thought  that  his  brother  was  there  talking.  He  tried  to  read 
The  Three  Guardsmen,  but  could  not  keep  his  mind  on  the 
book.  He  was  discharged  with  the  diagnosis  dementia  praecox, 
unimproved,  despite  the  fact  that  his  general  status  was  for 
the  moment  markedly  improved. 

The  social  service  now  took  charge  of  him,  and  for  a  period 


298  THE    KINGDOM    OF    EVILS 

of  some  two  years  there  is  a  running  record  which  gives  no 
sign  of  deterioration  whatever.  To  be  sure  his  former  em- 
ployers refused  to  take  him  back,  though  he  had  been  formerly 
six  years  employed  by  the  firm  in  a  rather  difficult  job.  He 
now  had  to  take  temporary  jobs  as  salesman,  acting  from  time 
to  time  as  an  extra.  Amongst  the  measures  of  the  social  serv- 
ice were  help  to  the  family  in  the  matter  of  clothes,  more  or 
less  continuous  reassurance  of  the  wife  as  to  the  nature  of  her 
husband's  situation  and  prognosis,  advice  concerning  work  on 
his  part  and  the  securing  of  vacations  for  the  children. 

Then  came  the  death  of  the  wife,  upon  learning  which  it 
was  thought  best  to  reopen  the  case  from  the  social  service 
point  of  view.  However,  despite  the  strain  of  the  situation 
the  family  succeeded  in  adjusting  itself,  with  the  oldest  daugh- 
ter, a  capable  girl  of  seventeen,  keeping  the  house.  Meantime 
Ernst  had  remained  steady,  was  working  regularly,  did  not 
drink  and  showed  no  sign  of  deterioration.  The  success  of 
the  family  adjustment  is  the  more  remarkable  when  it  is  con- 
sidered that  there  are  nine  children  (one  of  whom  is  choreic). 

Is  or  is  not  this  a  case  of  schizophrenia?  Perhaps  the  shrewd 
psychiatrist  might  say  that  time  only  would  tell.  Others  might 
say  that  it  was  a  case  of  dementia  praecox  that  had  gotten  well 
or  had  made  a  compensation  practically  equivalent  to  recovery. 
Others  might  insist  that  the  case  was  one  of  cyclothymia.  For 
our  part  we  may  content  ourselves  with  insisting  that,  which- 
ever of  these  diagnoses  is  rendered,  there  is  a  certain  statistical 
likelihood  of  error  in  diagnosis  with  our  present  knowledge 
(especially  perhaps  in  the  war  group  of  cases).  There  may 
be  noticed  many  instances  of  cases  looking  even  more  like 
schizophrenia  than  the  present  case  of  Ernst  and  yet  turning 
out  to  be  curable  or  capable  of  decided  remission.  Also  it  is 
worth  while  stressing  the  fact  that  the  term  "dementia"  in  the 
phrase  dementia  praecox  should  not  be  allowed  to  dominate 
anybody's  conception  of  the  disease  schizophrenia.  The  so- 
called  "dementia"  is  from  the  standpoint  of  all  clear-cut  cases 
a  matter  of  deterioration  of  the  emotions  and  not  at  all  neces- 
sarily or  characteristically  of  the  intellect.  The  layman,  social 
worker,  or  psychiatrist  makes  a  grave  error  who  carries  over 
any  ideas  that  he  may  possess  concerning  dementia  and  dements 
of  the  old  age  group  into  the  so-called  dementia  of  dementia 
praecox.     Perhaps  no  more  unfortunate  term  than  dementia 


THE    KINGDOM    OF    EVILS  299 

praecox  has  yet  been  devised  for  an  important  group  of  psycho- 
pathic patients. 

Hours  spent  by  Medical  record,  9  pages 

Social  record,  4  pages 
Physician,  7^  Social  work: 

Visits,  2 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  o 
Social  worker,  2  Letters,  i 


Spoiled  child.  Suicidal  attempts:  state  hospital:  dementia 
praecox?    Marriage  to  soldier  after  birth  of  child:  deserted. 

Case  74.  Nora  McCarthy  was  rather  a  spoiled  child 
coming  from  a  not  too  intelligent,  quarrelsome,  and  alcoholic 
family.  She  could  not  finish  high  school  because  she  got  "tired 
out"  and  "nervous."  It  seems  that  she  got  depressed  rather 
often  and  several  times  tried  suicide,  once  being  taken  to  a 
state  hospital  for  a  month  after  a  suicidal  attempt  and  therein 
receiving  the  diagnosis  of  psychopathic  personality  from  which, 
perhaps,  there  should  be  no  dissent. 

For  some  two  years  she  had  been  at  home  doing  nothing 
whatever.  Then  she  became  engaged  to  a  very  excellent  young 
man  whom  she  had  known  a  year  and  who  was  about  to  enlist. 
They  wanted  to  marry.  Nora's  mother  refused,  whereat  Nora 
cried  continually  for  a  month,  refused  to  eat  with  the  family, 
was  sent  to  the  Psychopathic  Hospital  for  observation  and  was 
there  thought  to  have  schizophrenia  (dementia  praecox). 

It  was  now  discovered  that  she  was  pregnant.  The  fiance 
was  unable  to  get  a  furlough  for  marriage.  There  were  even 
preparations  for  an  eleventh-hour  marriage  as  he  was  en  route 
for  overseas.  In  point  of  fact  the  detachment  had  been  hur- 
ried from  train  to  ship  and  there  was  not  even  time  to  wire. 
An  attempt  at  a  proxy  marriage  was  made  but  there  was 
some  doubt  of  its  legality.  Her  fiance  wrote  regularly  and 
sent  her  money. 

At  the  hospital  she  was  given  mental  tests  and  was 
found  to  grade  at  I4j^  years  on  the  Stanford-Binet  Scale. 
Her  failure  lay  not  so  much  in  intellectuality  but  in  im- 
pulsive and  hasty  answers.     She  was  physically  quite  normal, 


300  THE    KINGDOM    OF    EVILS 

psychiatrically  some  of  her  talk  about  her  family  might  give 
ground  to  the  suspicion  of  her  being  paranoidal,  but  on  the 
whole  her  statements  seemed  to  be  accurate  or  merely  exag- 
gerated. Emotionally  she  was  somewhat  depressed  and  at 
times  gave  the  appearance  of  apathy.  It  was,  no  doubt,  upon 
this  latter  ground  that  the  idea  of  dementia  praecox  obtained. 
In  retrospect  it  would  seem  that  a  good  deal  of  this  abnormal 
emotional  appearance  was  really  due  to  her  feelings  about  her 
pregnancy. 

She  remained  for  a  time  as  a  voluntary  patient  under  ob- 
servation and  then  went  home,  where  she  at  first  did  nothing. 
Gradually  she  became  interested  (in  part  under  the  visitor's 
stimulation)  in  making  baby  clothes.  The  baby  was  born  be- 
fore its  father  returned  from  overseas.  She  worried  about  the 
supposed  nervousness  of  "the  poor  little  thing."  She  gradually 
became  interested  in  housework  and  grew  interested  m  taking 
care  of  the  baby  even  to  the  point  of  absorption.  A  proper 
marriage  had  been  celebrated. 

At  this  point  the  social  service  closed  the  case.  It  appears 
from  the  record  that  this  decision  was  influenced  by  Mrs.  Mc- 
Carthy's statement  that  Nora  was  "very  happy  and  well  and 
not  at  all  depressed,  taking  an  interest  in  her  baby  and  in  the 
household."  The  closing  note  reads :  "Case  closed  since  pa- 
tient is  doing  well  and  further  visits  would  simply  antagonize 
her  and  her  mother.  Her  mother  is  keen  enough  to  recognize 
new  mental  symptoms  quickly  and  to  insist  upon  patient's  re- 
porting to  the  doctor."  Perhaps  the  fact  that  the  McCarthys 
lived  at  some  distance  from  the  hospital  and  on  top  of  a  steep 
hill  may  have  influenced  the  decision  to  close  the  case.  Pos- 
sibly the  fact  that  several  times  the  visitor  climbed  the  hill  only 
to  be  told  that  Nora  was  out  had  also  played  its  part.  At  any 
rate,  it  was  judged  that  her  husband  could  not  take  care  of 
Nora;  and  it  was  left  to  Mrs.  McCarthy  to  explain  her  con- 
dition to  him.  The  young  couple  were  to  live  with  the 
McCarthys. 

Five  months  later  the  social  worker  received  a  letter  from 
Nora  saying  that  her  mother  would  not  allow  her  to  talk  with 
the  social  worker  in  the  past  but  that  she  must  see  someone 
now  as  she  was  in  great  trouble.  Her  husband  had  gone  to 
make  a  visit  to  his  father  several  months  before  and  had  not 


THE    KINGDOM    OF    EVILS  3OI 

returned.  He  had  communicated  with  her  several  times,  but 
without  letting  her  know  his  address.  The  explanation  of  this 
unexpected  conduct  in  a  man  of  excellent  reputation  has  not 
yet  been  found.  She  was  advised  to  take  legal  action  to  trace 
him.  Meanwhile  she  is  working  as  cashier  in  a  department 
store,  and  living  at  home.  She  still  complains  of  her  family 
but  manages  to  get  on  with  them. 

Hours  spent  by  Medical  record,  36  pages 

Social  record,  28  pages 
Physician,  5^  Social  work: 

Visits,  53 
Psychologist,  i  Interviews  at  hospital,  3 

Telephone  calls,   10 
Social  worker,  81  Letters,  18 


Girl  committed  after  three  years'  observation.  Intensive  so- 
cial treatment.  Diagnosis  altered  from  psychoneurosis  to 
schizophrenia. 

Case  75.  We  cannot  regret  the  kind  or  the  degree  of  social 
work  carried  out  in  the  case  of  Clara  Goldberg;  yet  in  the 
sequel  it  might  be  thought  that  a  good  deal  of  someone's  time 
was,  for  Clara  Goldberg  at  least,  wasted. 

We  choose  the  Goldberg  case  as  one  of  dementia  praecox. 
In  the  end,  over  three  years  after  our  original  observation,  the 
girl  was  duly  committed  to  a  state  hospital,  with  the  usual 
prognosis  of  cases  of  dementia  praecox,  that  is,  with  the  great 
likelihood  of  a  persistent  deterioration. 

We  noted  above  in  the  case  of  Alfred  Stevens  (case  25)  an 
instance  wherein  the  change  of  medical  diagnosis  proved  of 
the  utmost  importance.  The  alteration  of  the  diagnosis  from 
psychasthenia  to  cyclothymia  (manic-depressive  psychosis)  in 
the  case  of  Stevens  worked  out  tremendously  to  his  benefit; 
for  his  stay  in  the  state  institution  led  to  the  smoothing  out 
of  his  depression  and  his  rehabilitation.  Clara  Goldberg  is  an 
instance  of  alteration  of  diagnosis  from  the  psychoneurotic 
group  to  the  schizophrenic  (dementia  praecox)  group.  The 
commitment  of  Clara  Goldberg  to  an  institution  for  chronic 
cases  no  doubt  makes  it  somewhat  easier  for  the  girl  herself 
and  straightens  out  many   family  problems.     In  the  present 


302  THE    KINGDOM    OF    EVILS 

phase  of  medical  science  this  will  no  doubt  be  the  issue  in  the 
majority  of  cases  of  schizophrenia  (dementia  praecox). 

Let  us  first  consider  her  appearance  and  behavior  at  the 
time  of  her  final  commitment  as  a  case  of  dementia  praecox. 
She  was  then  twenty-two  years  of  age  and  had  just  entered  the 
hospital  with  a  record  of  not  having  eaten  anything  for  several 
days.  She  volunteered  the  statement  that  she  was  a  bad  girl 
and  a  flirt  and  did  not  deserve  to  eat.  Direct  questions  she 
answered  correctly,  but  often  wore  a  silly  expression,  hiding 
her  face.  For  the  most  part  she  refused  to  talk.  When  asked 
a  question  she  sometimes  appeared  as  if  about  to  say  some- 
thing but  her  words  failed  to  come;  she  was  "blocked."  She 
was  constantly  seen  sitting  in  a  chair  with  her  head  inclined 
forward  and  the  saliva  running  from  her  mouth.  Now  and 
then  her  hands  and  arms  would  shake  violently.  Her  pupils 
were  dilated.  For  the  rest  the  physical  examination  was  not 
remarkable. 

A  psychological  examination  would  have  been  at  this  time 
impossible.  Clara  had,  however,  been  under  out-patient  de- 
partment observation  for  three  years  and  had  twice  had  a 
psychological  examination.  The  second  time,  about  a  year 
before  her  appearance  in  the  above  described  characteristically 
schizophrenic  state,  she  made  by  the  Point  Scale  a  level  of  13.5 
years,  grading,  in  fact,  somewhat  higher  than  she  had  graded 
on  the  previous  examination  a  year  before.  She  did,  however, 
show  on  the  second  examination  much  poorer  planning  ability 
than  she  had  at  first  shown. 

Looking  back  upon  her  history,  it  is  now  easy  to  see  schizo- 
phrenic traits.  She  is  described  as  having  had  many  manner- 
isms from  the  early  teens,  such  as  touching  her  face  and  teeth 
constantly  and  continually  moving  the  muscles  of  her  face. 
Efforts  to  curb  these  mannerisms — she  felt  that  her  expression 
was  silly  and  even  made  definite  efforts  to  change  her  expres- 
sion— resulted  in  movements  worse  than  ever. 

In  the  later  teens  it  appears  that  she  became  untidy  in  her 
person.  It  was  wasteful,  she  thought,  to  have  money  spent 
on  clothes.  She  would  eat  dry  bread  between  meals  so  that 
the  bread  might  not  be  wasted.  A  habit  of  masturbation  had 
begun  at  thirteen.  It  is  not  even  impossible  that  her  deteriora- 
tion had  begun  at  school  days  (for  instance,  she  spent  three 
years  in  the  seventh  grade). 


THE    KINGDOM    OF    EVILS  303 

Clara's  mother  had  had  two  attacks  of  manic-depressive  psy- 
chosis, and  Clara  had  a  sister  known  to  be  excitable. 

A  year  before  the  conditions  described  above,  Clara  Gold- 
berg was  the  object  of  considerable  attention.  The  social 
workers  described  themselves  as  at  the  end  of  their  particular 
rope.  They  wanted  to  know  what  to  do.  The  impression  of 
this  earlier  phase  was  different.  Notes,  for  example,  ran  at 
a  staff  meeting :  The  patient  came  in  shrinking,  with  eyes  red- 
dened from  weeping.  She  sat  herself  down  and  kept  twisting 
in  her  chair  with  her  head  downcast.  She  was  apparently 
laboring  under  great  emotion.  She  answered  haltingly  and 
in  a  low  voice.  In  response  to  questions  she  said  that  her 
conscience  did  not  work,  that  she  was  not  the  right  sort  of 
person,  that  she  had  caused  a  certain  social  worker  to  leave 
the  hospital,  and  finally  she  burst  out  weeping  loudly. 

After  the  interview  and  a  presentation  of  all  available  facts, 
there  was  a  remarkable  split  in  the  opinions  of  the  staff,  some 
of  the  more  mature  and  experienced  physicians  lining  them- 
selves on  both  sides  of  the  question,  psychoneurosis  versus 
schizophrenia.  The  purposefulness  and  emotionality  of  her 
reactions  suggested  psychoneurosis  to  several  competent 
workers.  Still  it  was  noteworthy  that  when  the  "pragmatic 
rule"  was  applied  and  the  question  was  asked  zvhether  the  pa- 
tient was  committable  or  not,  eight  persons  out  of  eleven  felt 
that  she  was  at  that  time  committable  and  but  three  felt  that 
she  was  not  committable.  Now,  inasmuch  as  on  the  whole 
psychoneuroses  are  probably  best  treated  outside  of  state  in- 
stitutions, whereas  on  the  whole  schizophrenics  are  best  treated 
in  state  institutions,  this  opinion  on  the  part  of  the  staff  is 
noteworthy.  Observers  who  saw  a  large  psychoneurotic  ele- 
ment in  Clara  Goldberg  were  nevertheless  inclined  to  think 
she  would  do  best  in  a  state  institution. 

It  sometimes  appears  that  the  application  of  this  "pragmatic 
rule,"  What  would  you  do  for  the  case?  is  technically  superior 
to  asking  the  question.  What  particular  disease  is  this  patient 
suffering  from?  To  be  sure,  great  authorities  agree  that  one 
cannot  make  the  generic  diagnosis  of  mental  disease  safely 
without  specifying  the  particular  kind  of  mental  disease  that 
the  patient  is  assumed  to  have.  No  general  statement  that  a 
patient  is  "insane,"  "unbalanced,"  "deranged,"  is  quite  safe  to 
accept.     When  the  particular  type  of  mental  disease  cannot 


304  THE    KINGDOM    OF   EVILS 

be  agreed  upon  by  a  large  and  active  medical  staff,  it  appears 
to  be  good  technique  to  ask  the  pragmatic  question  as  indicated 
above. 

With  respect  to  social  treatment,  some  recommendations 
early  made  were  as  follows : 

1.  Mother's  attitude  should  be  changed  to  one  of  encourage- 
ment instead  of  fussy  concern  over  Clara. 

2.  Occupation  should  be  secured  for  the  patient,  an  occupa- 
tion interesting  to  her;  if  possible,  with  small  remuneration. 

3.  The  girl  should  be  educated  by  being  placed,  if  possible, 
in  a  domestic-science  class. 

4.  She  was  to  be  influenced  to  mix  more  with  girls  of  her 
own  age. 

5.  She  was  to  report  regularly  to  the  out-patient  depart- 
ment for  medical  observation  and  treatment,  and  she  was  to 
attend  a  gymnasium  for  her  physical  development. 

The  results  of  treatment  cannot  be  very  briefly  stated.  While 
(a)  living  at  home  she  failed  to  show  improvement.  She  went 
from  one  relative's  home  to  (b)  another,  thence  to  (c)  a  con- 
valescent home  and  thence  to  (d)  a  working  girls'  home. 
Finally  money  was  raised  to  send  her  to  (c)  a  small  summer 
camp  for  girls,  whence  she  went  back  to  (/)  the  home. 
Arrangements  were  made  for  (g)  medical  treatment  through 
payments  by  her  sister.  She  was  engaged  (//)  to  tell  stories  to 
children  at  a  settlement  playground  and  she  was  even  somewhat 
successful  in  this.  She  was  got  to  go  to  (/)  a  cooking  class  and 
then  to  (/)  a  pottery  class.  She  was  taught  (k)  to  knit  and 
kept  persistently  at  the  task  of  knitting  a  muffler,  though  the 
winter  was  over  before  the  muffler  was  finished.  She  learned 
(/)  to  do  simple  office  work  in  a  fortnight  at  a  public  stenog- 
rapher's office  and  then  did  (m)  voluntary  work  for  some 
weeks  in  the  office  of  a  civic  organization.  Then  she  served 
(n)  as  an  errand  girl  in  a  dressmaking  shop.  All  these  em- 
ployers reported  that  she  was  useful  and  willing.  She  received 
no  pay  for  this  work  -which  was  regarded  as  educational.  At 
the  summer  camp  she  entered  into  all  sports  and  games  such  as 
basketball,  archery,  and  swimming.  Physically  she  was  greatly 
improved  by  her  stay  at  the  camp,     (o)     Her  teeth  were  filled. 

Whereas  at  home  she  had  made  no  physical  improvement, 
she  improved  steadily  after  her  first  stay  at  the  convalescent 
home.    The  mannerisms  that  she  had  had  since  the  early  teens 


THE    KINGDOM    OF    EVILS  305 

became  less  noticeable.  She  became  able  to  meet  and  talk  with 
other  persons  without  much  embarrassment.  She  looked  rather 
pretty  and  appealing  and  dressed  attractively.  She  spontane- 
ously bought  Christmas  presents  for  social  workers. 

About  ten  months  before  she  fell  into  the  utter  dilapidation 
described  at  the  outset  of  this  description,  Clara  began  to  fall 
off  in  her  working  capacity.  She  obtained  work  in  a  biscuit 
company  but  had  no  confidence  in  her  ability  to  do  the  work 
and  shortly  gave  it  up.  She  became  slower  in  all  her  processes. 
She  began  to  accuse  herself  and  said  she  was  not  earning  her 
board.  Her  employers  in  the  biscuit  factory  liked  her  well 
enough  but  found  her  in  the  end  "impossible."  Her  statements 
and  phrases  became  peculiar.  She  said,  "I  have  burned  my 
sister  inside  of  me."  She  told  the  forewoman  to  discharge 
her,  saying  that  she  (Clara)  was  silly-looking  and  no  good  and 
that  she  had  turned  the  hair  of  two  of  the  doctors  gray.  She 
was  reticent,  seclusive,  and  very  forgetful  at  the  mill.  At  lunch 
time  she  would  disappear  with  her  package  very  mysteriously 
and  return  in  time  for  work.  H  addressed  by  the  forewoman 
she  would  tremble  and  shake  and  be  unable  to  work. 

Here  then  was  a  fairly  promising  case,  as  cases  go,  of  de- 
mentia praecox.  Here  was  a  case  with  a  good  deal  of  emotion- 
ality and  apparent  insight  with  considerable  ambition.  It  was 
always  possible  up  to  the  last  to  exert  the  kind  of  influence 
upon  her  which  occupational  therapeutists  desire  to  use.  Her 
mannerisms  had  developed  very  early  and  appeared  to  have 
but  a  superficial  relation  to  the  main  currents  of  her  emotions 
and  will.  Was  or  was  not  the  progress  of  the  schizophrenic 
process  in  Clara  Goldberg  postponed  or  slowed  down  by  the 
social  work,  rest,  treatment,  and  occupational  therapy  ? 

Aside  from  the  obvious  physical  improvements  above  noted, 
can  we  safely  allege  that  her  psychosis  was  slowed  up?  The 
only  concrete  point  we  can  make  is  based  upon  the  two  special 
psychological  examinations  at  a  year's  interval,  the  second  about 
a  year  before  her  commitment  (at  which  time  a  psychometric 
estimate  would  have  been  impossible).  These  two  psychologi- 
cal examinations,  so  far  as  they  go,  give  the  impression  that, 
up  until  about  a  year  before  the  final  slump,  Clara  Goldberg's 
deterioration  was  not  actively  in  process.  This  conclusion  is 
in  accord  with  the  maintenance  of  her  general  social  status  and 
working  capacity  up  to  and  beyond  the  time  of  the  second 


306  THE    KINGDOM    OF   EVILS 

psychometric  examination.  Clara,  it  is  worth  noting,  found 
her  own  jobs  for  the  most  part  during  the  years  of  our  treat- 
ment. The  last  one  in  which  she  failed  was  no  doubt  too  hard 
for  her. 

Can  it  be  that  with  superior  light  and  power  over  what  we 
have  at  command,  a  simpler  job  without  the  disturbing  ele- 
ments of  exact  and  monotonous  mill  work  and  without  the 
presence  of  great  numbers  of  fellow  workmen  would  have 
saved  her  from  immediate  deterioration?  The  question,  some 
might  say,  is  of  little  importance,  since  in  the  long  run  a  patient 
like  Clara  Goldberg  is  bound  to  decline.  This,  some  would 
say,  is  the  almost  universal  history  in  true  cases  of  schizo- 
phrenia (dementia  praecox).  Even  concede  this  unhappy  trend 
to  be  the  rule,  it  is  nevertheless  of  the  utmost  importance  to 
pursue  more  intensive  studies  of  just  this  sort,  punctuated  by 
occasional  psychometric  examinations,  so  that  we  may  get 
some  further  light  upon  the  interior  of  the  schizophrenia 
problem. 

No  doubt,  under  the  conditions  favoring  occupational  ther- 
apy of  modern  state  institutions,  the  Goldberg  girl  will  become 
a  sufficiently  effective  hospital  worker,  though  of  no  great 
industrial  value.  Accordingly,  although  we  probably  should 
not  have  carried  out  quite  such  extensive  therapeutic  measures 
in  Clara  Goldberg  unless  she  had  shown  many  psychoneurotic 
features  over  and  above  schizophrenic  traits  in  the  early  period 
of  her  medical  observation,  we  cannot  be  sorry  that  so  much 
work  was  done. 

Hours  spent  by  Medical  record,  44  pages 

Social  record,  42  pages 
Physician,  20^4  Social  work: 

Visits,  45 
Psychologist,  2  Interviews  at  hospital,  33 

Telephone  calls,  32 
Social  worker,  90  Letters,  116 


Negro  soldier  cited  for  bravery.  Dangerous  paranoid  con- 
dition after  discharge. 

Case  76.  George  Stone,  a  negro  soldier,  who  enlisted  early 
in  1918,  made  an  honorable  record  overseas.  His  discharge 
papers  stated  that  he  was  in  several  battles,  received  a  citation 


THE    KINGDOM    OF   EVILS  3P7 

for  bravery  in  escorting  an  officer  through  shell-fire,  and  was 
cited  for  the  croix  de  guerre.  He  was  gassed  and  in  conse- 
quence was  declared  eligible  for  compensation  on  the  ground 
of  "pain  in  the  region  of  the  heart  and  lung  defects."  He  was 
first  sent  in  as  a  voluntary  patient  by  the  Red  Cross,  four 
months  after  his  discharge  from  the  army. 

He  had  married  immediately  upon  his  discharge  a  widow 
about  his  own  age  (he  was  thirty-seven),  who  had  shortly 
after  joined  a  religious  sect  that  absorbed  a  good  deal  of  her 
time.  Stone  began  coming  to  the  Red  Cross  office  nearly  every 
day  complaining  that  his  wife  stayed  out  all  night  and  read 
the  Bible  all  day  in  bed,  would  not  cook  for  him,  and  did  not 
care  for  him  "since  she  got  that  religion."  He  talked  inces- 
santly and  laughed  a  good  deal  in  a  silly  manner.  As  he  thought 
the  pains  around  his  heart  were  being  made  worse  by  his 
troubles,  it  was  easy  to  get  him  to  go  to  the  hospital.  He  was 
very  jealous  of  his  wife  and  thought  she  was  trying  to  injure 
him.  He  told  her  if  she  bowed  to  a  man  on  the  street  he 
would  kill  him. 

The  case  was  diagnosed  as  a  "paranoid  condition"  and  com- 
mitment was  advised.  But  as  Stone  was  not  considered  dan- 
gerous he  was  allowed  to  go  home.  Within  a  month  he  was 
brought  back  by  the  police,  to  whom  his  wife  had  turned  for 
protection.  Meanwhile  he  had  gone  to  Washington  for  a 
physical  examination,  in  order,  he  said,  to  prove  to  his  wife 
that  he  was  not  well,  as  she  said  he  was.  Now  he  accused  his 
wife  of  infidelity  and  believed  she  was  trying  to  get  rid  of  him 
in  order  to  obtain  his  pension  money.  He  wrote  letters  to 
prominent  officials  complaining  and  asking  protection  from  his 
wife.  He  believed  that  he  had  two  hundred  thousand  dollars 
invested.  He  said  he  felt  wonderfully  healthy  and  was  happy 
because  God  was  in  his  soul.  This  time  he  v*^as  committed  but 
escaped  from  the  hospital  and  started  to  his  old  home  in  the 
South.  Through  Red  Cross  channels  he  was  steered  into  a 
hospital  in  Washington  and  returned  here. 

Hours  spent  by  Medical  record,  37  pages 

Social  record,  2  pages 
Physician,  7^  Social  work: 

Visits,  o 
Psychologist,  i  Interviews  at  hospital,  2 

Telephone  calls,  0 
Social  worker,  2^  Letters,  6 


308  THE    KINGDOM    OF    EVILS 

Left  a  state  hospital  and  enlisted. 

Case  77.  George  Mullen  was  a  single  man  of  twenty-five, 
who  was  born  in  Canada  but  had  spent  most  of  his  life  in  a 
New  England  state  where  his  family  live.  In  191 5  he  was  in 
this  hospital  suffering  from  dementia  praecox.  He  was  com- 
mitted to  a  state  hospital  for  mental  diseases  and  discharged 
after  five  months.  He  immediately  sailed  for  England  and 
enlisted  in  the  British  Army.  He  fought  in  France,  was 
wounded,  and  returned  home.  He  seemed  indifferent  to  his 
family,  was  excitable,  talked  continually  about  money.  After 
a  week  at  home  he  attempted  to  cash  a  check  that  he  had  signed 
with  the  name  of  a  prominent  financier,  whose  partner  he 
claimed  to  be.  After  observation  at  this  hospital  he  was  again 
committed  to  a  state  insane  hospital  with  the  diagnosis  of 
dementia  praecox  confirmed. 

Hours  spent  by  Medical  record,  13  pages 

Social  record,  i  page 
Physician,  3^  Social  work : 

Visits,  o 
Psychologist,  0  Interviews  at  hospital,  I 

Telephone  calls,  o 
Social  worker,  i  Letters,  2 


Discharged  from  the  National  Guard  as  a  case  of  dementia 
praecox.  Drafted:  again  discharged.  Claimed  to  be  faking 
mental  disease. 

Case  78.  Paul  Dawson  was  first  admitted  to  the  Psycho- 
pathic Hospital  two  years  ago.  At  that  time  he  was  twenty- 
three  and  had  recently  married  a  girl  of  seventeen.  He  had 
always  been  a  great  liar,  had  never  worked  long  at  a  time,  and 
had  loafed  a  good  deal  between  jobs.  A  year  before  he  had 
joined  the  National  Guard  and  been  sent  to  the  border.  He 
claimed  that  he  had  "faked  mental  disorder"  while  there  with 
his  regiment  and  that  he  knew  the  symptoms  since  he  had 
worked  at  times  as  attendant  in  state  hospitals.  He  was  dis- 
charged from  the  service  with  the  diagnosis  dementia  praecox 
(the  diagnosis  of  the  Psychopathic  Hospital  physicians  also). 

He  was  sent  home  from  the  border  to  his  father  under  guard. 
He  and  his  wife  then  went  to  live  with  her  family,  but  Dawson 


THE    KINGDOM    OF    EVILS  309 

got  into  a  quarrel  with  the  in-laws  and  they  were  put  out. 
They  were  taken  in  by  his  family,  but  when  Dawson  made  no 
attempt  to  get  work,  his  father  refused  to  keep  his  wife,  now 
pregnant.  She  returned  alone  to  her  own  home,  where  she 
received  a  somewhat  cold  welcome.  Dawson  continued  to  loaf 
and  drink,  insisting  that  his  wife  return  to  him,  but  making 
no  attempt  to  support  her.  Although  several  positions  were 
suggested  to  him,  he  failed  to  go  to  work.  His  wife  insisted 
that  she  would  not  "give  him  up,"  but  finally  she  settled  down 
to  the  necessity  of  making  her  home  indefinitely  with  her  fam- 
ily. When  later  her  husband  was  drafted,  she  received  an 
allotment.  After  the  birth  of  a  fine  boy,  her  attitude  was  that 
she  would  return  to  him  if  he  would  "make  a  man  of  himself." 

When  war  was  declared  Dawson  at  first  decided  to  enlist, 
saying  it  would  be  better  to  do  that  than  be  drafted,  but  then 
he  came  to  the  conclusion  that  he  would  wait  for  the  draft.  He 
was  taken  into  the  army  in  the  spring  of  1918  and  four  months 
later  was  sent  to  the  Psychopathic  Hospital  from  camp  with 
the  following  statement  on  the  admission  blank : 

"Insomnia,  weakness,  pains,  and  poor  appetite.  Feared 
return  of  old  mental  trouble.  Hears  voices  and  sees  people 
about  his  bed;  has  delusions  that  he  has  put  electric  wires 
about  his  bed  to  keep  enemies  away;  believes  wife  trying  to 
poison  him  and  wants  to  do  his  own  cooking.  Will  not  speak 
to  any  patient  or  be  spoken  to." 

He  claimed  again  that  his  mental  disorder  was  "faked."  He 
had  written  his  family  from  camp  that  he  meant  "to  put  up  a 
game,"  because  he  did  not  want  "to  go  across"  and  that  he 
would  "give  the  doctors  a  run  for  their  money."  The  physi- 
cians believed  that  he  had  delusions,  which  he  denied  and  tried 
to  conceal,  and  made  the  diagnosis  of  unclassified  paranoid 
psychosis.  He  worked  for  four  months  at  a  state  institution 
and  then  joined  the  merchant  marine  where  he  became  chief 
petty  officer  on  a  ship  sailing  for  China. 

Hours  spent  by  Medical  record,  23  pages 

Social  record,  17  pages 
Physician,  6^  Social  work: 

Visits,  22 
Psychologist,  i  Interviews  at  hospital,  5 

Telephone  calls,  35 
Social  worker,  41 J4  Letters,  4 


310  THE    KINGDOM    OF    EVILS 

Corporal  who  developed  dementia  praecox  in  camp. 

Case  79.  Howard  Lancaster  when  drafted  was  doing  ex- 
ceptionally well  in  a  bonding  house.  He  worked  hard  and 
efficiently  and  spent  his  leisure  time  studying  law.  He  had 
always  been  inclined  to  be  seclusive  and  a  little  suspicious,  and 
he  had  times  of  being  depressed,  when  he  thought  he  was  not 
doing  his  work  well  and  that  his  associates  were  talking  about 
his  falling-off.  He  tried  to  enlist  and  was  rejected  because  of 
a  defective  eye;  but  later  he  was  drafted.  After  two  or  three 
weeks  in  camp,  he  was  promoted  to  corporal.  After  two 
months  he  became  ill,  acting  and  talking  in  a  silly  manner,  say- 
ing that  he  heard  voices  forbidding  him  to  perform  his  duties. 
The  diagnosis  was  dementia  praecox.  He  was  committed  to  a 
hospital,  but  in  a  month  had  improved  enough  to  be  discharged 
"on  visit"  to  his  family. 

Hours  spent  by  Medical  record,  34  pages 

Social  record,  2  pages 
Physician,  4V2  Social  work: 

Visits,  I 
Psychologist,  i  Interviews  at  hospital,  i 

Telephone  calls,  0 
Social  worker,  2  Letters,  2 


Army  captain  zvith  dual  personality.    Arrest  for  forgery. 

Case  80.  Major  Dobson  (who  proved  to  be  Captain 
James  Hill)  was  sent  for  examination  by  federal  authorities 
after  arrest  on  the  charge  of  having  forged  a  check  for  one 
thousand  dollars  under  the  name  of  Major  Mark  S.  Dobson. 
He  claimed  a  dual  personality  but  could  not  explain  it.  He 
said  that  he  used  two  names,  because  he  had  two  fathers,  one 
of  whom  was  dead,  the  name  of  the  living  one  being  Hill.  He 
believed  that  he  had  the  rank  of  major  and  that  the  check  he 
tried  to  cash  was  his  pay  check.  He  thought  that  Captain 
Hill  had  been  discharged  but  that  Major  Dobson  was  still  in 
the  service.  Although  he  had  lived  all  his  life  in  Florida,  he 
claimed  that  part  of  him  had  been  educated  in  Europe.  His 
conduct  had  been  peculiar  for  several  months, — in  France  he 
had  wandered  about  for  a  month  (he  said  he  knew  what  he 
was  doing  but  could  not  control  it).     He  had  been  hearing 


THE    KINGDOM    OF    EVILS  3II 

people  say  such  things  as,  "Kill  him."  He  was  worried  about 
himself  and  anxious  for  help  in  solving  his  problem.  The 
newspapers  had  his  story  under  the  headline,  "Afflicted  by 
Shell-Shock." 

Captain  Hill  had  seen  several  terms  of  army  life.  He  enlisted 
in  1912  and  purchased  release  in  1913;  reenlisted  in  1914  and 
again  purchased  release  in  191 5.  In  1916  he  went  to  an  offi- 
cers' training  camp  and  was  commissioned.  He  served  eighteen 
months  in  France  and  was  once  wounded.  While  overseas  he 
cabled  a  proposal  of  marriage  to  a  girl  he  had  known  for  two 
years,  a  dancer  in  a  comic  opera  company.  They  were  married 
on  his  return  and  the  week  that  Hill  was  taken  into  custody,  his 
wife  went  on  tour.  The  court  charge  of  forgery  was  dropped 
when  the  hospital  physicians  submitted  the  diagnosis  dementia 
praecox  and  the  captain  was  sent  to  his  family  for  hospital  care. 

Hours  spent  by  Medical  record,  19  pages 

Social  record,  8  pages 
Physician,  4^4  Social  work : 

Visits,  I 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  11 
Social  worker,  5^2  Letters,  4 


SECTION  IX 

CYCLOTHYMOSES    ( MANIC-DEPRESSIVE   PSYCHOSES) 

Young  woman  with  spells  of  wandering  and  eroticism. 
Three  diagnoses  rendered — psychoneurosis,  dementia  praecox, 
manic-depressive  psychosis.  Importance  of  diagnosis  in 
treatment. 

Case  8i.  We  find  stretched  on  the  records  in  the  case  of 
Winifred  Reed  three  different  psychiatric  diagnoses;  namely, 
psychoneurosis,  dementia  praecox,  and  manic-depressive  psy- 
chosis. 

Of  all  the  diagnoses  in  the  whole  of  psychiatry  no  doubt 
these  three  offer  the  maximum  of  difficulty.  To  be  sure,  'we 
place  in  an  eleventh  or  miscellaneous  group  of  psychoses  sundry 
conditions  of  still  greater  obscurity,  both  as  to  their  nature 
and  frequently  as  to  their  diagnosis.  Yet  these  eleventh  group 
cases  of  psychopathia  are  indeed  so  obscure  that  they  prac- 
tically defy  analysis,  but  the  three  diagnoses  that  come  in  ques- 
tion with  Winifred  Reed  fall  into  groups  which  in  our  Psycho- 
pathic Hospital  experience  we  place  just  ahead  of  the  eleventh 
group.  The  schizophrenic  group  (dementia  praecox)  we  have 
placed  eighth  in  our  list;  the  cyclothymic  (manic-depressive) 
stands  ninth ;  and  the  psychoneurotic  group  stands  tenth.  In 
short,  after  we  have  swept  aside  the  major  diagnostic  groups 
of  a  more  definite  character,  we  find  ourselves  confronting 
groups  of  cases  of  great  diagnostic  difficulty  and  very  doubtful 
genesis.  It  will  be  the  task  of  the  psychiatry  of  the  future  to 
unravel  the  cause  or  causes  of  the  schizophrenic,  cyclothymic, 
and  psychoneurotic  disorders.  Nor  can  we  undertake  in  this 
book  to  expound  at  any  length  the  psychiatric  nature  of  these 
or  any  other  conditions.  Let  us  insist  that  whatever  doubt 
may  at  bottom  prevail  concerning  the  nature  and  causes  of 
these  types  of  disease,  nevertheless  their  treatment,  once  a  par- 
ticular diagnosis  is  rendered,  is  almost  always  specifically  indi- 
cated.   Let  us  insist  with  all  emphasis  that  it  makes  every  dif- 

^12 


THE    KINGDOM    OF    EVILS  3I3 

ference  to  the  medical  and  social  treatment  of  a  case  of  mental 
disease  whether  it  receives  the  diagnosis  schizophrenia  (demen- 
tia praecox),  cyclothymia  (manic-depressive  psychosis) ,  or 
psychoneiirosis.  Moreover,  let  us  insist  that  it  makes  a  differ- 
ence to  the  patient  even  when  the  diagnosis  is  incorrect.  We 
have  above  considered  the  interesting  case  of  Alfred  Stevens 
(case  25)  to  whose  fate  the  matter  of  a  psychiatric  diagnosis 
was  of  extreme  importance.  It  will  be  remembered  that  Alfred 
Stevens  was  erroneously  classified  as  a  psychoneurotic,  was 
amply  treated  therefor,  failed  to  make  progress,  and  was 
promptly  put  on  the  right  road  again  when  the  correct  diagnosis 
(manic-depressive)  was  rendered.  It  will  be  recalled  that  as 
soon  as  Stevens  was  called  a  manic-depressive  he  was  forthwith 
prevailed  upon  to  enter  a  state  hospital,  wherein  all  his  troubles 
quite  smoothed  out. 

Winifred  Reed  was  not  very  long  seriously  considered  a 
psychoneurotic;  nor  was  psychotherapy  of  the  sort  indicated  in 
psychoneurosis  used  upon  her.  (In  this  instance,  as  every- 
where when  we  speak  of  psychotherapy  and  its  applicability  or 
non-applicability  to  a  case,  we  are  obviously  not  talking  about 
such  advice  and  counsel  as  are  properly  given  to  every  normal 
person ;  we  are  talking  about  psychotherapy  deliberately  chosen 
and  planned  to  affect  the  particular  rationalization  of  a  particu- 
lar difficulty.)  The  vital  issue  lay  between  the  diagnoses  of 
dementia  praecox  and  manic-depressive  psychosis.  In  the  end, 
Winifred  Reed  proved,  we  believe,  to  be  a  victim  of  manic- 
depressive  psychosis,  but  still  she  was  for  a  long  time  regarded 
as  a  victim  of  dementia  praecox.  Omitting  consideration  of  the 
medical  data  for  and  against  these  diagnoses,  what  are  the 
prognostic  features  that  bear  upon  social  treatment?  The 
psychiatric  social  worker  must,  of  course,  rely  upon  the  medi- 
cal diagnosis  (erroneous  though  it  may  be  in  fifteen  or  twenty 
per  cent  of  cases  amongst  these  dubious  groups)  and  must  pro- 
ceed on  the  hypotheses  that  underly  these  respective  diagnoses. 

We  ordinarily  think  of  dementia  praecox  as  a  progressive 
mental  disease  without  characteristic  tendency  to  recovery. 
Per  contra  we  ordinarily  think  of  manic-depressive  psychosis 
as  a  disease  with  a  strong  tendency  to  recovery  and  to  recur- 
rence. If  these  ideas  are  taken  boldly  at  their  face  value,  then 
the  logician  might  conclude  that  this  victim  of  dementia  prae- 
cox tending  to  an  incurable  dementia  might  as  well  forthwith 


314  THE    KINGDOM    OF   EVILS 

proceed  to  his  finish  in  some  receptacle  for  the  chronic  insane. 
Per  contra  the  logician  might  conceive  that  this  victim  of  manic- 
depressive  psychosis  being  likely  to  get  well  at  least  of  this 
particular  attack,  might  well  be  tided  over  his  attack  at  home. 
But  these  conclusions  of  the  logician  taking  the  classical  prog- 
noses on  their  face  value  would  land  us  in  many  a  quagmire. 
The  fact  is  that  the  schizophrenic,  flattened  out  and  leveled 
down  as  he  may  to  a  greater  or  less  extent  become,  can  often 
find  a  suitable  nidus  in  his  own  home  or  somewhere  in  the 
community  outside  hospital  walls.  Contrariwise,  the  manic- 
depressive  can  be  tided  over  his  attack  at  a  home  only  with 
extremes  of  difficulty  which  are  quite  unwarranted.  You  may 
perhaps  at  any  time  set  up  an  institutional  equivalent  in  a 
private  home,  with  day  nurses  and  night  nurses  and  constant 
medical  care,  but  ten  to  one  you  have  not  helped  the  patient's 
own  attitude  to  his  disorder  in  the  slightest  and  there  has  been 
a  very  trifling  gain  in  the  avoidance  of  whatever  stigma  now 
remains  for  the  mental  case  in  the  modern  community.  Far 
better  is  it  that  the  tiding  over  shall  be  more  effective  and  safely 
accomplished  within  the  walls  of  a  hospital.  Moreover,  if  we 
attach  to  the  benefits  of  the  hospital  stay  the  value  of  precise 
records  for  comparison  with  the  data  of  future  attacks  and  the 
potential  virtues  of  social  work  in  family  adjustment,  then  we 
feel  that  there  can  be  no  doubt  medically  or  socially  of  the 
propriety  of  sending  these  particular  curables  to  hospitals.  We 
again  arrive  at  an  apparent  absurdity;  namely,  that  curables 
should  he  forthwith  hospitalized  and  that  incurables  shall  he 
kept  in  the  cotnrminity.  Obvious  though  this  conclusion  is,  it 
nevertheless  proves  difficult  to  make  the  world  understand  it. 

Winifred  Reed  was  first  admitted  to  the  Psychopathic  Hos- 
pital when  twenty-four  years  of  age.  The  physician  who  sug- 
gested that  she  ought  to  be  observed  said  that  she  had  been 
much  depressed  and  thought  she  was  "crazy."  There  was  a 
history  of  her  having  wandered  for  two  days  and  a  night  in 
the  late  autumn,  hoping  to  die  from  starvation  and  exposure. 
Again,  in  the  dead  of  winter,  she  had  walked  off  knee-deep  in 
snow,  to  the  point  of  freezing  her  feet,  again  with  the  idea  of 
dying  from  exposure.  Upon  examination  there  was  little 
psychiatrically  to  find;  she  had  a  considerable  insight  into  her 
situation.  Aside  from  depression  and  over-active  reflexes, 
she   seemed  mentally  and  physically  normal   enough.     After 


THE    KINGDOM    OF    EVILS  315 

elaborate  discussion  at  staff  meeting,  the  staff  felt  inclined  to 
make  the  diagnosis  dementia  praecox,  though  psychoneurosis 
was  also  considered. 

She  was  then  dismissed  to  the  social  service,  who  fell  into 
sundry  difficulties  with  her.  Her  father  was  alcoholic.  Her 
mother  was  a  Christian  Scientist.  It  seems  that  the  father  had 
become  intemperate  when  Winifred  was  about  ten  years  old, 
and  had  steadily  become  more  and  more  of  a  drunkard  (ap- 
pearing at  one  time  in  a  state  hospital).  The  girl  had  been  a 
stenographer  without  special  responsibilities.  It  is  not  quite 
certain  what  the  first  mental  symptoms  were  and  when  they 
occurred.  It  appears  that  she  lost  her  job  through  an  odd  bit 
of  behavior  which  has  never  been  explained  (she  charged  a 
fellow  employee  with  stealing  another's  hat).  She  then  lost 
another  job  after  some  three  weeks  and  then  tried  to  act  as  a 
salesman  for  her  father.  It  appears  that  Winifred  talked 
rather  boldly  about  being  "sporty."  Some  employers  thought 
that  she  was  "man  crazy."  It  was  difficult  to  decipher  the 
course  of  her  conduct  because  of  the  unreasonable  character 
of  the  father.  At  one  time  the  girl  was  kept  in  the  back  part 
of  her  father's  shop,  and  customers  were  assured  that  the 
girl  was  kept  there  because  she  was  going  crazy.  Just  before 
coming  to  the  hospital,  Winifred  had  become  careless  and 
indifferent,  though  previously  energetic  and  bright.  In  fact, 
Winifred  had  obtained  unusually  good  grades  at  the  high  school 
from  which  she  had  graduated. 

It  is  difficult  or  impossible  to  unravel  some  of  the  features 
of  her  history.  There  is  no  doubt  that  she  was,  in  the  stock 
phrase  of  the  employers,  "man  crazy"  from  time  to  time.  She 
herself  dated  her  excess  of  erotic  passion  from  the  age  of 
twenty-one,  when,  according  to  her  story,  she  had  sex  inter- 
course for  the  first  time.  According  to  the  girl,  she  had  tried 
to  fight  against  her  intensity  of  passion  but  was  not  able  to 
control  it.  In  the  same  (twenty-first)  year,  there  was  also  a 
period  of  depression  which  lasted  about  three  months.  Nothing 
connects  this  depression  directly  with  the  initial  sex  intercourse. 
These  periods  of  depression  have  come  on  from  time  to  time 
every  year  since,  and  in  fact  have  increased  in  frequency  as 
well  as  in  duration. 

If  one  read  the  history  as  we  have  just  reviewed  it  there 
might  seem  to  be  little  doubt  of  the  patient's  being  a  victim 


3l6  THE    KINGDOM    OF    EVILS 

of  manic-depressive  psychosis.  Her  general  excitability  of 
temper,  her  attacks  of  depression,  and  her  erotic  episodes  and 
trend  would  be  entirely  consistent  with  the  diagnosis.  If  we 
look  back,  however,  at  the  picture  which  she  presented  upon  her 
first  admission  to  the  hospital  after  her  fugue-like  wanderings 
into  the  woods  and  snow,  and  if  we  bear  in  mind  her  change 
of  character  and  indifference,  to  say  nothing  of  the  oddities  of 
her  behavior,  then  we  shall  readily  see  how  the  diagnosis  of  a 
mild  dementia  praecox  could  have  been  set  up. 

At  all  events,  such  is  the  general  opinion  of  Winifred  Reed. 
The  best  line  appeared  to  be  to  manage  her  in  the  community 
with  such  moral  support  of  the  girl  herself  and  of  the  family 
as  might  keep  her  on  a  fair  level  of  social  efificiency.  Despite 
the  fact  that  the  prognosis  of  dementia  praecox  would  run  to  a 
certain  impairment  of  personal  and  social  efficiency,  yet  from 
our  social  endeavors  with  the  girl  and  with  her  associates  much 
might  be  hoped.  An  endeavor  was  made  to  separate  her  from 
her  alcoholic  father  and  socially  inadequate  mother  and  to  put 
her  at  suitable  employment.  The  first  step  consisted  in  sending 
her  to  a  convalescent  home.  From  this  house  she  forthwith 
escaped  and  repaired  to  her  own  home.  Twice  afterward  she 
was  also  placed  in  convalescent  homes,  but  whether  from  a  con- 
valescent home  or  from  good  conditions  in  some  job  that  was 
got  for  her,  Winifred  Reed  never  failed  to  leave;  she  would 
repair  to  her  home  and  there  keep  in  hiding  for  a  time,  eventu- 
ally telephoning  to  the  hospital  for  help.  Her  eroticism  and 
her  odd  behavior  did  not  abolish  the  fidelity  of  a  patient  ad- 
mirer who  stood  by  her  throughout,  and  though  practically 
engaged  to  the  girl,  never  married  her. 

Eventually,  after  some  seventeen  months,  the  overt  act 
which  so  often  supervenes  with  psychopaths  occurred.  Ap- 
parently she  had  a  fresh  outburst  of  eroticism  (which  is  medi- 
cally to  be  regarded  as  a  form  of  attack  in  her  disease).  She 
was  arrested  for  cohabitation  and  again  brought  to  the  hospital. 
The  diagnosis  seemed  now  to  be  much  plainer  than  in  the  be- 
ginning. Instead  of  community  care,  with  the  securing  of 
jobs  for  which  she  was  not  ready,  and  difficult  supervision, 
she  was  accorded  hospital  treatment.  In  two  months  she  could 
be  discharged  to  probation.  Her  attack  of  slight  mania  had 
subsided.  The  further  steps  in  this  case,  in  which  similar 
attacks  are  only  to  be  expected,  are  part  of  a  rather  clear 


THE    KINGDOM    OF    EVILS  31/ 

program.  With  this  diagnosis  in  hand,  it  seems  as  if  Winifred 
Reed  could  in  future  be  managed  with  considerable  if  not  with 
absolute  success. 

Hours  spent  by  Medical  record,  64  pages 

Social  record,  50  pages 
Physician,   13  Social  work: 

Visits,  23 
Psychologist,  2  Interviews  at  hospital,   13 

Telephone  calls,  122 
Social  worker,  81  Letters,  16 


Cyclothymic  waiter  came  to  the  out-patient  department 
because  he  lacked  initiative. 

Case  82.  William  Donahue,  thirty-six,  came  of  his  own 
volition  to  the  Psychopathic  Hospital,  out-patient  department, 
saying  he  had  had  depressed  spells  from  a  boy  up.  He  said  he 
was  confident  enough  of  his  ability  to  work,  but  "lacked  initia- 
tive." He  said  too  that  he  had  considerable  trouble  in  getting 
on  with  other  people,  being  regarded  as  a  "grouch."  It  ap- 
peared upon  conversation  that  he  had  had  short  periods  of 
exhilaration.  The  diagnosis  of  manic-depressive  psychosis 
was  soon  made  by  the  psychiatrist,  and  Donahue  was  referred 
to  the  social  service  for  employment.  This  was  procured  at 
a  department  store.  He  worked  there  for  a  number  of  months, 
but  reported  from  time  to  time  that  he  had  not  quite  got  back 
to  his  best  form. 

Donahue  was  never  referred  to  the  wards  of  the  hospital, 
but  was  handled  from  the  out-patient  department  and  the  social 
service.  It  seems  he  had  worked  always  rather  irregularly,  usu- 
ally as  a  waiter.  His  head  had  been  split  open  when  he  was 
knocked  down  by  a  runaway  horse  at  the  age  of  eight.  Dona- 
hue had  never  been  very  strong,  had  never  taken  much  part  in 
games  with  other  boys,  and  had  been  out  of  school  a  great  deal 
owing  to  sickness.  His  father  was  a  heavy  drinker.  No  spe- 
cial mental  tests  were  made  upon  Donahue.  He  often  left  his 
jobs,  which  rarely  lasted  over  a  few  months,  for  no  reason 
whatever.  He  always  wanted  to  work  on  his  own  responsibility. 
He  wanted  to  be  let  alone  and,  if  he  was  not  let  alone,  he  did 
not  want  to  stay.    He  was  self-supporting  except  between  jobs, 


3l8  THE    KINGDOM    OF    EVILS 

when  he  was  dependent  upon  relatives.     He  was  now  in  debt 
to  relatives  and  to  the  dentist. 

Amongst  the  measures  of  treatment  given  the  patient,  it  was 
suggested  that  he  attend  the  Men's  Club.  He  became  a  most 
regular  attendant  thereat.  One  important  measure  was  the 
explanation  to  his  employers  of  his  exact  condition  and  reports 
to  them  of  his  improvement  as  it  grew.  Social  treatment  in- 
cluded such  items  as  follows : — 

Interview  to  discuss  possibility  of  advancement  at  his  depart- 
ment store ; 

To  persuade  patient  of  the  necessity  of  more  aggressiveness 
on  his  part  for  the  purpose  of  getting  promoted ; 

To  increase  his  self-confidence  and  to  widen  his  interests  and 
increase  his  acquaintance. 

A  letter  would  occasionally  be  sent  to  express  the  visitors' 
regret  at  not  seeing  him  at  the  Men's  Club. 

The  situation  was  explained  to  the  secretary  of  a  voluntary 
association  in  which  he  took  out  membership. 

As  a  result  Donahue  did  greatly  improve  although  he  re- 
mained supersensitive  and  somewhat  lacking  in  confidence  and 
aggressiveness.  He  became  more  interested  in  reading  and  cur- 
rent events.  His  aggressiveness  w^ore  off.  He  felt  he  was  now 
doing  a  man's  work  and  was  filled  with  the  idea  of  getting  ahead 
in  the  world. 

This  is  an  example  of  the  handling  of  what  may  be  termed  a 
cyclothymic  constitution  (mild  manic-depressive  psychosis). 
The  more  we  look  the  more  examples  of  such  mild  or  severe 
cyclothymic  constitutions  are  found  in  all  corners  of  the  world. 
Precisely  these  patients  make  rather  good  workmen,  indeed 
sometimes  extraordinarily  good  workmen  if  their  psychopathic 
sides  are  understood  and  proper  adjustments  made.  Of  course 
neither  the  psychiatrist  nor  the  social  worker  should  attach  too 
much  significance  to  improvement  in  cyclothymic  cases,  at  least 
from  the  point  of  view  of  claiming  such  improvement  as  the 
result  of  treatment. 

As  demonstrated  elsewhere  in  this  book,  there  have  been 
numerous  cases  where  such  patients  have  improved  over  periods 
of  months  and  years  under  influences  beyond  our  knowledge. 
Still  there  can  be  no  doubt  that  direct  effects  are  obtained  upon 


THE    KINGDOM    OF    EVILS  319 

the  under  and  over  activities  of  some  of  these  cyclothymic 
patients  by  counsel,  encouragement,  and  direction  of  interests. 

Hours  spent  by  Medical  record,  i  page 

Social  record,   19  pages 
Physician,  iy'2  Social  work: 

Visits,  6 
Psychologist,  o  Interviews  at  hospital,   14 

Telephone  calls,  18 
Social  worker,  32  Letters,  19 


Governess  with  attacks  of  excitement  and  depression,  requir- 
ing hospital  care. 

Case  83.  Marie  Dubois,  forty,  was  a  bookkeeper,  very 
competent  and  well  educated,  of  French-Canadian  origin.  She 
had  a  spell  of  depression  at  about  thirty  years  of  age,  where- 
upon she  came  across  the  line  and  worked  variously  as  a  gov- 
erness and  a  bookkeeper,  holding  her  positions  for  long  periods 
except  during  the  year  preceding  her  arrival  at  the  hospital. 
We  surmise  that  her  succession  of  jobs  during  her  fortieth 
year  was  due  to  the  gradual  appearance  of  the  second  depres- 
sive phase.  Yet  there  was  a  more  striking  occasion  for  the 
eventual  necessity  of  hospital  care, — her  mother  died  and  two 
days  later  her  cousin.  This  cousin  she  had  been  living  with  as 
his  wife  but  without  legal  sanction,  since  her  religion  frowned 
upon  a  cousin  marriage.  She  then  fell  into  a  depression.  She 
was  profoundly  in  love  with  this  cousin.  She  wrote  in  her 
diary  of  how  he  died  of  a  Sunday  and  how  every  Sunday  fol- 
lowing she  grew  sad. 

It  was  some  six  months  after  the  paramour's  death  that  she 
got  into  a  rather  small  difficulty  which  brought  her  to  the 
hospital.  She  appeared  at  a  place  where  she  had  formerly 
worked  and  was  well  liked  and  wanted  to  sell  some  tickets  for 
a  charity.  She  was  allowed  to  set  up  her  booth.  She  set  this 
booth  up  rather  inconveniently  to  the  shop  but  claimed  that 
God  told  her  just  how  to  do  so  and  that  the  Cardinal  had 
blessed  her  sales.  She  got  very  angry  when  requested  to  move 
the  booth.  During  her  depression  she  had  been  rather  religious. 
She  tells  in  her  diary  of  having  gone  eighteen  times  to  see, 
understand,  and  enjoy  Billy  Sunday's  pantomime  remarking 


320  THE    KINGDOM    OF    EVILS 

that  "it  was  a  splendid  derivatif  from  my  recent  sorrow"  and 
that  she  "admired  his  perfect  subtlety  and  his  complete  under- 
standing of  the  masses  of  people." 

While  in  hospital  she  narrates  in  her  diary  how  "in  my  soul 
then  I  did  see  at  first  a  beautiful  grave  of  white  marble,  the 
top  stone  covering  herself  slowly  with  a  small  quantity  of 
tulle  (material  for  both  dresses  and  veils) .  It  was  a  young  lady 
in  the  grave.  I  was  helping  the  lover.  It  was  growing  and 
growing  in  my  very  presence  until  it  was  a  beauty.  Then  ap- 
peared under  this  soft  mass  some  wonderful  stems  of  white 
lilies.  I  have  never  seen  anything  so  beautiful  in  a  funeral 
marble  yet.  This  stayed  with  me  all  night,  but  in  the  meantime 
something  was  going  on  to  prepare  a  wonderful  Caliban  that 
the  committee  has  never  heard  of.  (Too  bad  it  is  only  in  my 
imagination.)" 

The  first  attack,  as  noted,  had  been  one  of  depression  and 
her  mood  after  the  death  of  her  mother  and  her  lover  had 
been  chiefly  a  depressive  one.  The  episode  of  the  ticket-selling 
was  a  sample,  however,  of  excitement  and  the  diagnosis  ren- 
dered at  the  hospital  was  that  of  manic-depressive  psychosis- 
manic  phase.  Miss  Dubois  was  very  restless  and  irritated  at 
the  time  she  was  examined.  She  could  not  concentrate  her 
attention.  She  grew  restless  and  required  packs  and  baths. 
She  would  sing  and  play  about  the  room  dramatically.  She 
remained  nude  a  part  of  the  time  but  seemed  not  so  much 
erotic  as  to  have  lost  for  the  time  being  her  delicacy.  (In  point 
of  fact  her  diary  records  a  considerable  delicacy  with  respect 
to  her  early  handling  by  the  nurses.)  Now  and  again  she 
would  seem  to  react  to  hallucinations  of  vision  and  hearing 
and  above  has  been  given  an  example  of  the  sort  of  visual  hal- 
lucination, if  it  be  one,  which  she  had.  The  imagery  was  more 
of  that  fixed  and  solid  sort  which  psychologists  have  recently 
discussed,  than  of  the  fleeting,  cinema-like  sort  which  we  are 
accustomed  to  find  in  the  psychoses.  She  assumed  no  fixed 
attitudes  at  any  time,  took  her  nourishment  willingly,  and  ap- 
parently had  a  rather  good  insight  into  her  abnormality  of 
mind.  Physically  she  was  almost  normal,  though  her  eyes  were 
a  bit  prominent. 

Upon  discharge  she  reported  from  time  to  time  to  the  out- 
patient department  and  the  notes  indicate  that  she  remained 


THE    KINGDOM    OF    EVILS  321 

exhilarated  for  some  six  months  further.  After  a  year  it 
seemed  to  the  out-patient  medical  staff  that  she  need  report  no 
longer  as  a  patient.  To  be  sure  she  was  a  little  overemphatic  in 
her  speech  but  perhaps  not  more  so  than  a  French-Canadian 
woman  should  be. 

Hours  spent  by  Medical  record,  22  pages 

Social  record,  15  pages 
Physician,  9^  Social  work : 

Visits,   20 
Psychologist,  o  Interviews  at  hospital,  2 

Telephone  calls,  8 
Social  worker,  35  Letters,  6 


Hyponmnic  hoy  on  probation:  ran  away.  A  "had  actor"  in 
school. 

Case  84.  Joe  Marino,  fifteen  years  old  when  he  was 
first  referred  to  the  hospital  from  a  juvenile  court,  is  a  kind  of 
adolescent  delinquent  that  psychiatrists  feel  belongs  pretty  cer- 
tainly in  one  of  the  more  definite  groups  of  mental  diseases, 
namely  the  so-called  manic-depressive  or  cyclothymic  group. 
He  yielded  the  impression  of  the  so-called  "hypomanic"  man- 
ner of  mild  overexcitement  when  he  first  came  to  the  hospital 
and  his  entire  history  seems  consistent  with  his  being  funda- 
mentally a  cyclothymic. 

He  was  a  short,  stocky  Italian  boy  with  rather  an  old-looking 
face.  He  was  very  talkative  and  noisy,  easy  enough  to  control 
but  apt  to  get  into  mischief  when  not  under  immediate  super- 
vision. It  seems  that  he  had  had  an  idea,  perhaps  an  obsession, 
about  going  to  California.  He  was  opposed  in  this  idea  at 
home  and  became  abusive  and  rather  violent  there.  He  boarded 
a  train  and  got  as  far  as  Providence,  when  he  was  picked  up  by 
the  police.  He  was  brought  back  to  the  juvenile  court  where 
he  had  twice  before  been  and  from  which  he  was  even  at  that 
time  on  probation.  Employers  had  always  found  him  way- 
ward and  impertinent,  and  he  had  never  stuck  to  a  job  longer 
than  five  weeks,  for  the  most  part  leaving  a  job  after  only  a 
few  days.  He  had  been  arrested  for  breaking  and  entering, 
had  ripped  off  plastering  in  unoccupied  houses,  and  was  re- 


322  THE    KINGDOM    OF    EVILS 

garded  as  a  "bad  actor"  in  school,  where  he  had  shouted  and 
broken  windows. 

He  was  one  of  seven  American-born  children  in  an  Italian 
family  that  lived  in  cramped  and  rather  squalid  quarters.  His 
father  got  rather  irregular  employment  but  was  somewhat  in- 
telligent and  well  disposed.  The  mother  was  an  ignorant  and 
excitable  woman  suspicious  of  interference  and  unreliable. 
The  other  six  children  were  lively,  jolly  children  and  not  espe- 
cially troublesome.  The  family  regarded  Joe's  visits  to  the  hos- 
pital as  rather  a  joke.  They  regarded  his  activity  and  pug- 
naciousness  as  due  to  his  being  "a  kid  and  full  of  fun."  Joe 
was  under  hospital  observation  in  all  for  about  seven  weeks  at 
two  different  times.  His  associations  and  his  replies  to  ques- 
tions were  very  rapid.  He  showed  very  well  the  symptom 
called  distractability.  picking  up  all  the  features  of  his  immedi- 
ate environment  and  weaving  them  into  the  conversation. 
Upon  staff  rounds,  for  example,  he  talked  as  if  he  were  in  a 
courtroom,  affixing  comments  to  the  bystanders,  calling  one  a 
lawyer,  another  a  witness,  another  a  stool  pigeon,  and  the  like. 
He  was  at  times  so  active  that  the  treatment  of  prolonged 
baths  was  executed ;  and  the  hypomania  so  verged  upon  a  true 
mania  that  the  committing  physicians  felt  themselves  entitled 
to  take  the  extreme  step  of  actually  committing  him  to  hospital 
by  procedures  of  the  probate  court. 

After  his  discharge  from  the  hospital  he  remained  "on  visit"  ; 
that  is,  on  the  books  subject  to  recall  for  a  year.  He  got  his 
picture  in  the  newspapers  at  one  time  by  desiring  to  enlist  in 
the  marines  as  a  water  boy  who  had  had  plenty  of  experience. 
He  said  that  as  his  name  was  Marino  he  ought  easily  to  get 
into  the  marines.  (Of  course  the  name  Marino  is  fictitious 
and  the  very  characteristic  maniacal  pun  which  the  boy  made 
was  actually  a  good  deal  more  complex  than  the  form  we  offer.) 

The  case  was  closed  by  the  social  service  some  eight  months 
after  his  first  appearance  at  the  hospital  although,  as  above 
stated,  his  name  was  carried  on  the  books  of  the  hospital  for  a 
year.  At  the  expiration  of  the  eight  months  it  would  seem  that 
the  great  wave  of  overexcitement  which  had  been  punctuated 
by  the  various  adventures  mentioned  was  now,  for  the  time 
at  least,  well  over.  Perhaps  Joe  will  appear  again  in  another 
phase  of  mania  or  possibly  even  of  depression  if  our  diagnosis 
of  cyclothymia  is  a  correct  one.     No  doubt  previous  experi- 


THE    KINGDOM    OF    EVILS  323 

ence  with  Joe  will  allow  for  rapid  and  accurate  decisions  con- 
cerning him  should  he  become  once  more  a  "bad  actor." 

Hours  spent  by  Medical  record.  14  pages 

Social  record,  17  pages 
Physician,  8j^  Social  work  : 

Visits,  13 
Psychologist,  0  Interviews  at  hospital,  I 

Telephone  calls,  8 
Social  worker,  25  Letters,  5 


Sailor  who  became  overactive.  Had  been  given  to  ''excited 
actions." 

Case  85.  The  following  is  Robert  MacPherson's  story  as 
recorded  by  the  social  worker,  when  she  interviewed  him  on 
the  wards  : — 

"The  patient  is  a  nice-looking  boy  with  a  very  pleasant 
manner,  which,  however,  seems  to  become  rather  suspicious  at 
times.  He  is  twenty-three  years  old.  He  was  born  in  Phila- 
delphia. The  family  came  to  Boston  when  he  was  a  baby. 
When  he  was  three  years  old,  his  mother  was  taken  to  a  state 
hospital,  and  he  and  his  younger  sister  were  placed  in  some 
sort  of  institution  at  that  time.  His  sister  developed  pneumonia 
and  died.  Patient's  father  took  him  at  that  time,  and  patient 
has  lived  with  him  since  then  until  a  year  ago.  Patient  says 
his  father  has  never  worked  very  steadily,  that  he  is  a  drinking 
man  and  so  was  his  father  before  him.  His  father  is  now 
about  sixty  years  of  age.  He  is  not  a  man  of  much  education 
and  patient  thinks  maybe  he  was  jealous  of  him  because  he 
got  so  far  ahead  of  him.  He  thinks  his  mother  was  quite 
educated.  He  does  not  know  how  old  she  is,  as  she  will 
never  tell  him.  She  is  now  in  a  state  hospital  where  he  goes 
to  see  her.  She  seems  all  right  but  at  times  if  she  becomes 
discontented  or  something  happens  to  upset  her,  she  is  liable 
to  create  quite  a  disturbance. 

"Patient  went  to  grammar  school,  then  to  a  high  school  of 
commerce  where  he  graduated,  and  also  graduated  from  an 
evening  high  school.  Then  he  went  to  a  commercial  college 
for  two  or  three  years  but  he  did  not  finish,  as  he  did  not 
like  the  course.  While  he  was  still  going  to  school  he  worked 
with  Weston  Brothers  as  a  clerk  (his  father  works  there  as  a 
packer).     He  also  worked  at  the  Plymouth  Publishing  Com- 


324  THE    KINGDOM    OF    EVILS 

pany  and  ushered  at  the  Lexington  Theater.  At  clerking  he 
would  make  about  three  dollars  a  week  a^d  at  ushering  he 
earned  fifty  cents  a  performance;  however,  he  thinks  the  latter 
is  'a  poor  way  to  earn  money.'  When  patient  started  work 
regularly,  he  started  in  at  the  National  Sugar  Company  where 
he  earned  nine  dollars  a  week.  Then  he  worked  at  the 
American  Electrical  Company,  earning  fourteen  dollars  a  week ; 
later  he  worked  for  the  Standard  Insurance  Company  'at 
eighteen  dollars  a  week.  He  was  two  years  there  and  he  says 
he  knows  enough  about  insurance  not  to  want  to  take  it  out. 

"When  war  was  declared  he  enlisted  in  the  naval  reserve;  he 
was  never  called  and  so  secured  his  discharge  August  21,  191 7> 
but  reenlisted  in  the  United  States  coast  guards.  He  was  on  a 
revenue-cutter.  About  July,  19 18,  he  was  sent  to  a  naval  hos- 
pital where  he  stayed  a  month.  He  was  circumcised  there. 
He  was  discharged  in  August,  1918.  It  was  about  this  time 
that  his  mental  trouble  began.  He  became  more  ambitious, 
attempted  things  he  had  never  done  before  and  led  'sort  of  a 
wild  life.'  He  had  saved  up  about  seven  hundred  and  fifty 
dollars  and  he  purchased  a  Big  Six  Buick.  He  says  that  is 
enough  to  show  he  was  'out  of  his  mind.'  He  would  invite 
everybody  to  ride  and  would  'kick  them  out'  just  as  quickly. 
He  sold  the  magazine,  The  Puritan,  and  because  he  was  in  uni- 
form he  made  quite  a  lot  of  money  and  he  spent  it  just  as 
quickly.  His  father  'kicked  him  out.'  After  his  discharge  he 
became  a  four-minute  man  and  it  was  while  he  was  speaking 
in  dififerent  theaters  that  he  was  advised  to  go  to  the  Fenway 
School  of  Oratory.  There  he  met  a  Mrs.  Reed.  They  oflfered 
to  give  him  lessons  and  after  a  time  Mrs.  Green  (who  was 
also  connected  with  the  school),  Mrs.  Reed,  and  Mr.  Reed 
(who  was  a  tea  salesman)  all  'vamped'  him,  so  that  he  went  to 
live  with  them.  He  says  he  will  do  anything  that  they  tell  him 
to  do.  Patient  later  went  to  work  with  the  United  Importa- 
tion Company.  At  first  he  was  a  checker.  Later  he  started  the 
follow-up  system  and  soon  established  a  department  of  adver- 
tising. When  he  started  he  was  the  only  one  in  the  department, 
but  now  there  are  six  and  he  is  the  head  of  the  department. 
His  salary  is  only  twenty  dollars  a  week ;  but  he  made  more 
on  the  side  in  business  deals  in  connection  with  the  firm.  He 
says  he  has  made  as  much  as  ten  thousand  dollars  at  one  time, 
but  he  does  not  often  make  these  sales.  Patient  wants  to  get 
into  the  foreign  department  and  wants  to  get  down  to  South 
America.  He  speaks  some  Spanish  which  he  studied  in  high 
school  and  has  made  arrangements  to  study  Portuguese  with 
the  son  of  a  former  ambassador. 


THE    KINGDOM    OF    EVILS  325 

"Patient  says  that  he  has  recently  become  interested  in  pur- 
chasing automobiles  again,  and  he  thinks  that  maybe  it  is 
because  he  has  been  doing  these  things  that  they  got  him  into 
the  hospital,  but  he  intends  to  sue  whoever  was  responsible  for 
having  him  'shanghaied'  here.  Patient  already  has  four  motor 
cycles,  a  motor  boat,  a  sail  boat,  a  deer  skin,  and  a  bear  skin, 
which  he  purchased  through  the  company  and  which  he  intends 
to  have  made  into  gloves  and  a  coat.  He  doesn't  know  how 
much  he  has  in  the  bank.  He  has  been  looking  up  Buick 
roadsters  and  on  Saturday  he  repeated  'the  same  sort  of  stunt' 
that  he  had  done  before,  just  after  he  was  discharged  from 
the  navy. 

"At  that  time  he  took  two  girls  out  riding  in  his  car,  drove 
them  out  a  mile  and  then  stopped  his  car  in  front  of  a  garage 
and  made  them  all  walk  home.  On  Saturday  he  asked  the 
same  girl  to  go  out  with  him  in  the  roadster,  which  he  was 
trying  out;  he  drove  her  over  to  the  garage,  where  he  made 
a  deposit  on  the  car;  he  left  the  car  there  and  took  her  home 
in  a  jitney,  Saturday  night  Mrs.  Reed  asked  him  to  lend  her 
four  hundred  dollars.  He  thought  this  was  very  queer  as  she 
had  never  made  such  a  request  before.  The  more  he  thought 
the  matter  over  the  queerer  it  seemed,  so  he  took  a  suitcase  and 
decided  to  go  back  to  his  father  to  stay  with  him  for  a  while. 
He  promised  to  let  them  know  when  he  got  to  his  father's,  so 
he  telephoned  them  and  they  asked  him  to  come  out.  He  and 
his  father  went.  He  says  that  while  they  were  there,  he  noticed 
that  they  kept  a  pretty  close  watch  on  him.  A  Dr.  and  Mrs. 
Foster  arrived,  who  were  evidently  friends  of  the  Reeds.  Dr. 
Foster  started  talking  to  him  and  seemed  to  draw  him  out,  but 
he  was  perfectly  willing,  so  he  talked  ahead.  The  doctor  said 
that  he  had  a  car  to  sell,  and  invited  him  to  come  riding  with 
him,  so  they  went  and  he  was  brought  here  to  the  Psychopathic 
Hospital.  Patient  says  that  'the  same  stunt  was  pulled'  on  his 
mother  twenty  years  ago  and  it  is  no  wonder  that  she  is  still 
in  a  state  hospital.  He  knows  that  there  is  something  wrong 
with  her  now,  but  his  father  has  never  told  him  what  happened 
twenty  years  ago.  He  would  like  to  know  about  it  as  he  thinks 
there  may  have  been  'some  crooked  work.'  " 

This  somewhat  highly  colored  story  if  taken  with  a  grain  of 
salt  gives  a  fairly  accurate  account  of  Robert's  experiences 
between  the  time  of  his  discharge  from  the  navy,  in  the  sum- 
mer of  1 91 8,  and  his  stay  in  this  hospital,  in  the  fall  of  19 19. 
He  was  very  talkative  and  active,  getting  into  difficulty  with  the 
other  patients.    He  had  no  marked  outbursts  of  excitement  but 


326  THE   KINGDOM    OF   EVILS 

was  continually  restless.  His  hypomanic  condition  made  in- 
definite hospital  care  necessary  and  he  was  transferred  to  the 
same  state  hospital  where  his  mother  was  a  patient. 

Before  enlistment  Robert  had  worked  in  an  insurance  office 
and  lived  with  his  father,  who  helped  out  with  his  expenses, 
so  that  he  had  been  able  to  save  about  seven  hundred  dollars. 
He  had  shown  average  ability  in  school  but  had  been  more 
interested  in  athletics  than  in  studies.  At  one  time  he  was 
engaged  to  a  girl  who  broke  the  engagement  on  account  of 
Robert's  "excited  actions."  He  did  not  show  any  great  or 
deep  regret  over  the  affair.  He  was  always  full  of  energy;  in 
the  habit  of  having  his  own  way  and  rather  self -centered.  He 
was  neat  in  his  personal  habits  and  did  not  show  peculiarities  of 
conduct  up  to  the  time  he  left  the  navy.  His  attack  of  excite- 
ment began  about  a  month  before  his  discharge. 

Hours  spent  by  Medical  record,  14  pages 

Social  record,  5  pages 
Physician,  3^  Social  work: 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  2 

Telephone  calls,  5 
Social  worker,  41/2  Letters,  5 


Enlisted;  gassed;  discharged.  Became  restless,  talkative, 
moralistic.     Voluntary  patient. 

Case  86.  Clarence  Adams  was  gassed  fourteen  months 
after  his  enlistment  and,  after  passing  through  several  hospitals 
in  France,  was  discharged  four  months  later  in  the  neighbor- 
hood of  Boston.  He  took  a  few  months'  vacation  and  then 
during  the  hot  weather  of  early  summer  held  a  clerical  position 
in  a  large  mill.  One  day  he  fainted  on  the  job  and  gave  it  up. 
He  held  several  other  positions  for  short  periods  but  was  over- 
active and  could  not  concentrate.  His  family  then  sent  him  to 
the  woods,  by  a  doctor's  advice,  in  company  with  a  man  com- 
panion. After  some  weeks  his  companion  felt  that  he  was 
not  improving  and  brought  him  back  to  Boston.  When  he  was 
admitted  to  the  Psychopathic  Hospital  he  was  restless  and  talk- 
ative. He  took  pleasure  in  reading  the  Bible  and  instructing 
the  patients  from  it. 


THE    KINGDOM    OF    EVILS  327 

Adams  was  now  twenty-six  years  old.  He  had  had  several 
attacks  previously,  the  first  four  years  before,  when  he  became 
absorbed  in  the  stock  market  and  speculated  recklessly.  At  this 
time  he  became  "moralistic,"  according  to  his  brother,  and  made 
efforts  to  bring  together  his  parents  who  had  been  separated. 
After  he  had  been  in  this  condition  a  year  the  family  sent  him 
to  a  private  hospital  for  mental  diseases,  where  after  five 
months  he  recovered.  Once  or  twice  after  this  he  resorted  to 
the  same  hospital  for  short  periods.  Adams  had  made  a 
rather  brilliant  record  in  school  and  after  entering  college  he 
had  done  well  for  a  year.  During  the  second  year  he  became 
"dissipated,"  contracting  gonorrhea.  He  was  in  the  second 
month  of  the  senior  year  when  he  went  into  the  army ;  and  he 
returned  to  college  and  got  his  degree.  During  his  term  of 
army  service  he  did  very  well,  so  far  as  can  be  learned. 

From  the  Psychopathic  Hospital  (where  he  was  a  voluntary 
patient)  he  went  of  his  own  accord  to  a  near-by  hospital,  as  a 
further  period  of  hospital  care  was  advised. 

Hours  spent  by  Medical  record.  14  pages 

Social  record,  6  pages 
Physician,  3^  Social  work: 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  I 

Telephone  calls,  3 
Social  worker,  334  Letters,  10 


SECTION  X 

PSYCHONEUROSES 

Cigar-maker  with  psychonetirosis.  Financial  worries:  dis- 
like for  his  trade.  Family  adjustments.  Different  forms  of 
psychotherapy.    Individualization. 

Case  87.  In  one  of  the  great  Atlantic  seaboard  hospitals 
(which  shall  be  nameless)  there  used  to  be  an  out-patient  de- 
partment diagnosis  Judaism,  although  the  diagnosis  Judaism 
was  probably  a  sly  Caucasian  hit  at  the  frequenters  of  the  clinic. 
There  is  some  basis  for  the  idea  of  a  preponderance  of  psycho- 
neurotics amongst  Jews.  But,  inasmuch  as  the  Jews  have  the 
excellent  habit  (from  the  mental  hygiene  point  of  view)  of 
very  speedily  resorting  to  physicians  for  their  ills,  the  statistical 
preponderance  of  Jews  in  many  Atlantic  seaboard  clinics  is 
perhaps  deceptive.  There  may  be  as  many  Caucasians  of  dif- 
ferent varieties  that  fall  victim  to  psychoneurosis  as  there  are 
Jews.  It  would  be  difficult  to  point  out  anything  really  differ- 
ential in  the  psychology  of  the  Jew. 

Maurice  Eastman  was  a  Russian  Jewish  immigrant,  forty 
years  of  age.  He  came  on  his  own  initiative  to  the  Psycho- 
pathic Hospital  complaining  of  indigestion,  stomach  trouble, 
constipation,  frequent  urination  for  months  at  a  time,  year- 
long headaches,  and  what  he  summed  up  as  nervousness.  In 
point  of  fact  various  doctors  told  him  he  was  a  victim  of 
nervous  instability,  nervous  prostration.  He  had  evidently 
been  coached  by  physicians  to  know  that  "it  was  all  foolish- 
ness." He  said  he  was  always  worrying,  always  afraid  (that 
the  children  would  be  killed,  that  there  would  be  accidents  while 
he  was  asleep).  He  was  unable  to  control  his  thoughts. 
He  had  what  would  almost  amount  to  a  symptom  in  itself; 
namely,  an  intense  and  analytic  interest  in  his  case.  He  slept 
well,  in  fact  he  always  felt  sleepy  and  tired,  but  even  more  tired 
on  rising.  He  knew  that  he  ought  to  "cheer  up  as  there  was 
nothing  the  matter,"  but  he  could  not.     He  had  read  an  ac- 

328 


THE    KINGDOM    OF    EVILS  329 

count  of  the  Psychopathic  Hospital  work  in  the  Sunday  news- 
paper. Later  interviews  showed  that  he  was  worried  over  his 
physical  condition,  over  family  finances,  over  increase  in  the 
number  of  children  (there  were  now  five  ranging  from  twelve 
to  two  years),  over  his  domestic  relations  and  over  practice  of 
self -abuse  which  he  thought  had  affected  his  health. 

Here  is  a  sufficiently  characteristic  picture  of  a  psychoneu- 
rotic with  many  features  suggestive  of  the  obsessive  or  psy- 
chasthenic. We  omit  further  medical  details,  insisting  merely, 
by  the  way,  that  the  above  picture,  although  characteristic,  can 
be  found  in  a  variety  of  other  mental  diseases  than  the  psycho- 
neurotic group.  (Particular  cases  of  that  sort  may  actually 
prove  to  be  syphilitic  and  greatly  improve  by  antisyphilitic 
treatment. ) 

Eastman  was  forthwith  placed  for  some  time  under  the  care 
of  a  student  in  psychology  who  had  made  a  special  study  of  the 
methods  of  psychotherapeutic  suggestion.  (This  sort  of  tech- 
nique can  still  well  be  studied  in  Bernheim's  excellent  old  work, 
Suggestive  Therapeutics,  as  well  as  in  sundry  newer  works  of 
Bernheim  that  carry  out  the  early  ideas  of  Liebault.  The 
patient  acknowledged  great  improvement  by  the  suggestions 
offered,  in  periods  of  one-half  to  three-quarter  hours,  and  ap- 
parently was  genuinely  much  improved  for  a  time.  Besides  the 
"talking  cure,"  he  was  made  to  read  popular  works  on  psycho- 
therapy. The  patient  thought  he  was  better  because  he  had 
learned  to  check  his  thoughts.  He  got  to  reading  many  books 
on  psychology  and  on  suggestion.  He  practiced  abstinence 
from  sex  intercourse  for  eight  months  at  one  time  so  that  the 
family  should  not  increase  too  rapidly. 

However,  he  continued  to  have  troublesome  symptoms  and 
feared  he  would  become  insane.  He  had  obsessions  of  several 
sorts  (when  he  saw  a  knife  he  wanted  to  stab  somebody  with 
it;  upon  looking  from  a  window  he  wanted  to  jump  out). 
While  these  psychotherapeutic  efforts  at  persuasion  were  going 
on,  occasional  hospital  visits  (at  the  same  time  patient  was  tak- 
ing hydrotherapeutic  treatments  there),  the  domestic  adjust- 
ment had  to  be  made.  The  mother  was  an  unusually  intelligent, 
thrifty  woman,  adept  at  cooking  and  sewing.  Eastman  him- 
self, although  he  had  gone  to  work  at  the  age  of  eleven  in 
Russia,  had  picked  up  a  fairly  good  education,  knew  several 
languages,  and  read  some  philosophy.     He  hated  his  cigar- 


7^0  THE    KINGDOM    OF    EVILS 

making  trade  although  he  earned  good  wages  thereat.  The 
family  income  was  just  enough  to  meet  current  expenses,  left 
no  margin  for  clothes,  and  allowed  only  tenement-house  life  on 
a  shabby  street,  overcrowded  with  very  poor  neighbors.  It  is 
clear  that  several  of  these  domestic,  economic,  and  social  fea- 
tures cannot  easily  be  met  by  psychotherapy,  either  of  the  sim- 
ple "Cheer  up"  or  "Forget  it"  kind  or  the  more  elaborate  and 
subtle  practice  by  the  student  of  psychology  in  Eastman's  case. 
There  was  a  social  (family)  problem  as  well  as  the  individual 
one.  Possibly  it  is  the  social  problem  both  superadded  to  and 
lying  deeply  underneath  the  individual  problem  that  has  caused 
physicians  to  fail  in  the  past  to  effect  cures  in  many  psycho- 
neuroses,  despite  the  fact  that  a  very  perfect  individual  psycho- 
therapeutic technique  was  being  thoroughly  carried  out.  It  is 
an  error  of  the  psychiatrist  and  the  psychologist  to  rest  pro- 
found faith  in  arm-chair  methods  of  psychotherapy.  It  is 
great  merit  of  the  medical  social  worker  in  general  and  the  psy- 
chiatric social  worker  in  particular  to  have  shown  the  faults 
of  this  arm-chair  method  taken  by  itself.  Meantime  the  social 
worker  must  not  fail  to  acknowledge  the  extraordinary  results 
of  some  therapy  in  camera,  such  as  the  amazing  results  of 
hypnotism  in  selected  cases  and  the  equally  amazing  results  by 
psychoanalytic  treatment  of  patients  reporting  from  time  to 
time  in  the  consulting  room  of  the  psychiatrist.  Our  tiresome 
old  formula.  Circumstances  alter  cases,  is  the  only  true  formula 
to  apply  to  the  whole  field  of  psychiatric  social  work. 

If  there  is  anything  which  this  book  stands  for  it  is  plainly 
the  individualization  of  the  diagnosis  and  treatment  of  psychiat- 
ric cases.  The  adherents  to  one  or  other  method  of  psycho- 
therapy (such  as  hypnotism,  psychoanalysis)  are  rather  apt  to 
overdraw  their  statistical  values  in  any  psychiatry.  The  social 
worker  has  to  steer  her  way  very  carefully  betwixt  these  vari- 
ous statistical  prejudices  of  the  enthusiastic  adherent  of  some 
method  that  is  a  perfect  success  in  some  cases.  It  is  as  requi- 
site for  the  psychiatric  social  worker  not  to  cry  up  the  wares  of 
a  particular  kind  of  psychotherapeutist,  as  it  is  for  the  psychiat- 
rist himself  to  bear  in  mind  that  there  is  more  than  one  way 
to  "kill  a  cat."  Of  course,  when  one  is  in  Rome,  one  must  do 
as  the  Romans  do.  In  a  large  part  of  France  during  the  war, 
hypnotism  was  officially  forbidden  as  a  method  of  treatment  for 
those  psychoneuroses  familiarly  termed  "shell-shock."     Never- 


THE    KINGDOM    OF    EVILS  33 1 

theless,  elsewhere  in  France  and  in  other  belligerent  countries, 
hypnotism  was  being  employed  in  some  selected  cases  with 
positive  and  even  startling  results.  The  modern  formulations 
of  psychotherapy  are  not  so  many  decades  old  that  they  will  not 
be  greatly  molded  and  revamped  before  the  last  word  is  said. 
When  all  is  said  on  the  matter,  however,  the  doctrine  of  the 
treatment  of  the  individual  as  such  remains  the  common  pos- 
session of  all  forms  of  psychotherapy. 

After  all  the  psychiatric  social  worker  does  not  by  virtue  of 
contacts  with  psychopathy  become  a  psychiatrist.  The  fact  that 
she  may  know  more  about  individual  details  and  technique  of 
family  adjustment  than  the  psychiatrist,  does  not  cause  her  to 
have  sound  ideas  concerning  the  central  psychopathic  figure  in 
the  family  under  adjustment.  In  the  same  sense  the  student  in 
psychology  employed  in  the  case  of  Maurice  Eastman  might 
have  been  wasting  his  own  and  everybody's  time  by  perfectly 
correct  technical  endeavors  in  treating  a  man  with  many  of 
the  same  symptoms  which  Eastman  possessed  who  should 
happen  to  be  not  psychoneurotic  at  all.  One  of  our  Psycho- 
pathic Hospital  patients  who  had  been  regarded  for  five  years 
as  psychoneurotic  is  described  in  Neurosyphilis;  he  was  actually 
syphilitic  and  the  patient  plaintively  inquired  why  it  had  taken 
so  long  to  establish  a  diagnosis.  Neither  the  social  worker  nor 
the  psychologist  can  be  expected  to  avoid  pitfalls  such  as  that 
case  presented.  On  the  other  hand,  it  is  just  as  certain  that 
the  psychiatrist  has  neither  training  nor  time  to  execute  the 
family  adjustments  undertaken  by  the  psychiatric  social 
worker.  Nor  has  a  psychiatrist  often  the  time  and  perhaps  the 
temperament  to  execute  persuasive  therapy  in  its  best  form. 
Indeed,  we  are  sometimes  tempted  to  think  that  different  types 
of  psychotherapeutist  will  eventually  prove  necessary  for  differ- 
ent types  of  psychopathy,  just  as  different  sorts  of  automobiles 
suit  different  temperaments.  All  of  which  is  another  example 
of  our  constant  insistence ;  that  is,  that  psychiatrists  as  psychiat- 
rists are  not  social  workers  or  psychologists,  and  that  neither 
of  these  other  types  of  workers  is  likely  by  training  or  tem- 
perament to  be  able  to  swap  places  with  the  other  or  make 
more  than  snap  diagnoses  in  the  psychiatric  field. 

The  medical  measures  adopted  in  Eastman's  case  (persua- 
sive psychotherapy)  ceased  after  a  time,  as  all  the  internal  ad- 
justment that  could  be  made  in  this  way  had  apparently  been 


332  THE    KINGDOM    OF   EVILS 

accomplished.  The  man  was  apt  to  be  irritable  and  unreason- 
able at  home.  He  would  complain  of  the  children's  noise  which 
prevented  him  from  reading;  he  complained  that  his  lot  was 
harder  than  that  of  other  men  in  like  circumstances,  as  he  was 
more  intelligent  (this  was  true)  than  the  average  man.  He 
had  the  advantage  of  having  no  bad  habits  to  interfere  with 
his  being  a  good  steady  workman.  The  treatment  carried  out 
for  a  period  of  some  six  years  now  finds  him  much  better 
adjusted  to  his  lot  in  life.  No  other  form  of  work  could  be 
found  for  Eastman  that  would  bring  him  as  high  wages  as 
cigar-making.  As  the  family  was  after  all  not  destitute  it 
proved  impossible  to  get  supplementary  relief  by  means  of 
loans,  such  as  might  have  been  put  into  effect  for  certain 
indigent  families.  The  wife  and  children  were  getting  an 
annual  vacation  through  the  settlement  house  and  a  vacation 
was  now  arranged  for  Eastman  himself.  He  had  not  had  a 
vacation  in  all  of  his  adult  life.  He  helped  with  the  work  of 
the  Men's  Club,  and  from  time  to  time  pieces  of  work  were 
secured  for  the  wife  who  was  a  clever  needle  woman  to  sup- 
plement the  family  income.     Eastman  still  hates  his  work. 

Hours  spent  by  Medical  record,  2  pages 

Social  record,  35  pages 
Physician,  4  Social  work : 

Visits,  20 
Psychologist,  6  Interviews  at  hospital, 

Telephone  calls,  19 
Social  worker,  70  Letters,  18 


GIRL  OF  15  YEARS 


SOCIAL  CONDITION 

Hard  Work 
No  Recreation 
No  Training 
Insufficient  Income 
Feeble-minded  and  Inebriate 

Father 
Family  Discord 


19^5 

SOCIAL  CONDITION 

Light  Work 
Recreation 
Trade  Training 
Adequate  Income 
Home  with  Sister 

Separation  from  Family 


MENTAL  CONDITION 

Hysterical  Convulsions 
(2  in  one  month) 


MENTAL  CONDITION 

Hysterical  Convulsions 
(3  in  past  year) 


Girl  with  hysterical  convulsions.  Father  feeble-minded  and 
alcoholic.  Psychoanalysis.  Social  investigation.  Prolonged 
social  treatment.    Cure  or  alleviation. 

Case  88.  Sadie  Strauss  was  a  seventeen-year-old  Russian 
Jewish  girl,  a  case  of  hysteria  whose  cure  or  alleviation  could 
be  variously  claimed  at  different  times  by  psychiatrists  or  social 
workers.  Perhaps  neither  the  psychiatrist  nor  the  social  worker 
should  claim  too  much,  since  the  hysterical  trend  may  be 
ingrained  and  persist  for  years.  For  some  years,  however, 
there  have  been  no  clear  or  striking  hysterical  outbursts,  and 
only  traces  of  that  excessive  fear  reaction  which  some  of  her 
human  sisters  often  seem  a  little  proud  of — that  is,  fright  at  a 
mouse.  As  it  takes  more  than  one  swallow  to  make  a  summer, 
so  it  takes  more  than  one  case  to  break  the  general  medical 
conception  or  prejudice:  once  a  hysteric  always  a  hysteric.  In 
passing  we  make  remark  that  it  would  seem  that  the  war  experi- 
ences with  shell-shock  will  probably  serve  to  break  down  this 
old  conception. 

There  is  still  another  older  conception  of  hysteria  as  an 
''aristocrat"  amongst  the  functional  diseases,  that  is  as  markedly 
hereditary.  Concerning  heredity  in  Sadie  Strauss,  we  can  find 
only  that  the  father  is  perhaps  somewhat  feeble-minded;  pos- 
sibly his  low  mental  level  is  really  acquired,  i.e.,  alcoholic. 
Sadie  herself  was  determined  by  the  psychological  examiner 
to  be  normal.  She  was  deft  with  her  fingers,  but  did  not  prove 
very  resourceful  in  the  tests  for  planning  and  analysis.  She 
was  very  "suggestible,"  but  got  easily  discouraged  and  seemed 
more  than  normally  fatigable.  Her  measurement  by  the  Binet 
Scale  was  ii  4/5  and  by  the  Point  Scale  11  7/10. 

Menstruation  began  at  twelve.  Sadie  went  to  work  as  soon 
as  the  fourteen-year  law  allowed  and  was  working  on  piece 
work  in  a  mill  earning  from  six  to  seven  dollars  a  week  for 
fifty-four  hours'  work.  After  a  painful  menstruation  she  one 
day  collapsed,  feeling  a  lump  or  stone  in  the  stomach.  She 
was  taken  to  the  hospital,  then  home  again  and  back  to  the 
hospital,  where  there  was  a  seizure  of  pain,  screams,  laughter, 

335 


33^  THE    KINGDOM    OF    EVILS 

and  unconsciousness.  She  was  then  brought  to  the  Psycho- 
pathic Hospital.  It  appeared  that  she  had  fainted  two  or  three 
times  in  the  last  few  years. 

The  psychiatrists  could  find  no  abnormal  sign  upon  physical 
examination  either  on  the  motor  or  the  sensory  side.  In  an 
attack  she  rolled  from  side  to  side  on  the  couch,  held  an  arm 
or  leg  in  the  air,  was  sometimes  stiff,  sometimes  quite  relaxed, 
but  always  apparently  somewhat  conscious,  occasionally  assum- 
ing a  silly  expression,  sometimes  attitudinizing,  sometimes 
pointing  as  if  hallucinated  and  quite  mute.  She  did  not  bite 
her  tongue  or  void  urine.  This  particular  attack  was  slight 
and  took  place  during  an  interview  for  the  purpose  of  psycho- 
analysis. 

Psychoanalytic  conversations  finally  turned  up  news  of  an 
early  childhood  episode.  The  child  had  been  terribly  frightened 
by  having  to  undress,  one  night  when  alone,  her  drunken  father. 
This  episode  may  have  developed  sex-consciousness  prematurely 
or  it  may  have  provided  "buried"  memories  that  could  operate 
after  the  manner  of  the  Freudian  mechanisms.  In  conversa- 
tion it  developed  that  the  girl  dreamed  of  a  dark  man  in  a  white 
garment  who  chased  her.  The  man's  hands  were  her  father's, 
but  his  face  was  like  the  face  of  a  man  who  was  the  first  dead 
person  she  had  even  seen.  This  psychoanalytic  discovery 
might  have  been  supposed  to  work,  as  such  discoveries  some- 
times work,  by  the  so-called  method  of  psychical  "catharsis" 
to  effect  an  immediate  cure.  That  is  to  say,  if  there  was  a 
"buried  memory"  of  this  infantile  sex  experience,  then  (ac- 
cording to  the  theory)  talking  it  out  will  relieve  the  effects  of 
the  repression.  It  is  not  entirely  sure  that  the  memory  in 
question  was  buried  in  Sadie's  mind.  At  all  events  she  had 
some  eight  attacks  of  pronounced  hysterical  nature  after  the 
supposed  catharsis. 

Perhaps  it  will  not  do  to  quarrel  with  the  psychoanalyst  con- 
cerning his  therapeutic  results,  and  no  doubt  a  large  share  of 
the  effect  in  Sadie  Strauss'  case  is  to  be  awarded  to  the  psycho- 
analyst. Nevertheless  it  is  to  be  pointed  out  that  a  routine 
social  investigation  would  bring  out  very  promptly  informa- 
tion concerning  the  Saturday  night  debauches  of  the  father. 
A  good  deal  more  was  found  out  by  such  investigation  than 
the  psychiatrist  or  psychologist  could  discover  from  the  arm- 
chair.   The  father  was  in  point  of  fact  brought  to  the  clinic  and 


THE    KINGDOM    OF    EVILS  337 

proved  to  be  feeble-minded.  Supervision  of  his  life  yielded 
definite  improvement  in  the  family  condition,  although  he 
fell  from  grace  and  once  got  into  the  house  of  correction. 
There  were  many  more  than  merely  the  medical  and  tempera- 
mental problems  in  the  Strauss  situation.  Clothes  were  pro- 
vided for  Sadie,  so  that  she  could  go  to  the  trade  school  for  a 
year.  The  family  needed  Sadie's  wages  and  could  not  clothe 
her.  They  were  too  proud  at  first  to  accept  such  help  but  were 
eventually  persuaded.  The  patient  then  made  her  home  with 
her  sister ;  vacations  and  recreation  were  arranged  for ;  more 
or  less  regular  reporting  to  the  out-patient  department  was 
made  a  habit,  and  medical  encouragement  was  there  doled  out 
to  her. 

Two  and  one-half  years  after  her  initial  appearance  at  the 
hospital  Sadie  was  married.  She  had  matured  visibly  and  was 
now  capable  of  much  better  self-control.  Attacks  had  long 
since  stopped.  Her  husband  was  a  man  of  a  very  good  sort, 
and  the  case  could  appropriately  be  closed.  Her  husband  said 
that  he  gave  his  wife  pretty  things  and  let  her  have  her  own 
way  in  household  matters.  Outside  of  hospital  time,  some  of 
the  social  workers  attended  the  wedding. 

Hours  spent  by  Medical  record,  i8  pages 

Social  record,  40  pages 
Physician,   17^  Social  work : 

Visits,  44 
Psychologist,   i  Interviews  at  hospital,  24 

Telephone  calls,  37 
Social  worker,  107  Letters,  11 


Voluntary  patient  in  state  hospitals  from  time  to  time. 
Cyclothymia:  sex  obsession.     Industrial  adaptation. 

Case  89.  Joseph  Fangillo,  forty,  has  been  three  times  a 
voluntary  patient  at  the  Psychopathic  Hospital  and  has  also 
spent  some  time  at  the  hospital's  suggestion  at  one  of  the  state 
hospitals  also  as  a  voluntary  patient.  His  history  shows  that 
he  had  also,  at  the  age  of  thirty-four,  been  a  patient  at  one  of 
the  state  hospitals. 

He  has  received  a  number  of  diagnoses  but  he  is  probably 
best  classified  as  a  psychasthenic.     He  had  recently  gone  into 


338  THE    KINGDOM    OF    EVILS 

the  liquor  business  and  rightly  or  wrongly  felt  that  his  affairs 
had  been  going  downhill  ever  since.  Besides  there  had  been 
the  Billy  Sunday  campaign  and  there  was  the  national  pro- 
hibition movement.  In  addition  to  ideas  touching  money,  he 
had  some  obsessions  about  sex.  He  thought  that  he  had  an 
uncontrollable  sexual  desire  and  interest  and  felt  that  he  would 
be  tremendously  excited  if  he  saw  the  pictures  of  women  or  if 
he  came  at  all  in  contact  with  them.  He  complained,  too,  of  his 
eyes  although  there  was  no  objective  evidence  of  eye  disorder. 

If  we  regard  the  diagnosis  of  psychasthenia  as  correct  then 
it  is  plain  that  the  medical  and  social  contacts  with  Joseph 
Fangillo  will  mean  much.  His  five  different  hospital  experi- 
ences have  all  been  as  a  voluntary  patient.  In  fact,  the  last 
four  hospital  stays  have  been  part  and  parcel  of  a  single  psy- 
chasthenic phase  out  of  which  he  appears  now  to  have  passed, 
aided  by  the  direct  influence  of  counsel  and  family  adjustment 
between  himself  and  his  wife  effected  by  the  social  service. 
The  wife  is  intelligent  and  devoted  but  needed  a  great  deal  of 
encouragement  since  she  was  living  upon  the  family  savings. 

If  our  present  diagnosis  is  incorrect  and  he  is  actually  in 
some  sense  a  cyclothymic  patient,  then  so  far  as  we  are  now 
aware  the  thing  which  will  bring  him  out  of  a  given  phase  is 
rather  the  curative  power  of  nature  than  any  medical  or  social 
efforts  of  any  description.  However,  it  is  clear  that  if  Fan- 
gillo is  a  cyclothymic  and  the  course  of  his  disease  is,  as  the 
phrase  is  "self-limited,"  nevertheless  the  social  service  contact 
with  the  wife  and  the  counsel  to  her  with  respect  to  her  adjust- 
ment to  her  husband's  psychopathy  would  mean  a  great  deal. 

This  case  has  not  been  intensively  handled  by  physicians 
at  any  time  upon  any  specific  line  of  psychotherapy  such  as 
psychoanalysis.  The  sexual  obsessions  above  mentioned  may 
date  from  a  specific  occurrence  which  conversation  might  at 
last  unfold.  The  psychoanalyst  and,  for  that  matter,  all  kinds 
of  therapeutists,  would  hope  from  all  cases  of  psychoneurosis 
for  a  fundamental  cure  by  the  process  of  so-called  reeducation 
or  rationalization.  Without  entering  the  debatable  confines  of 
the  psychoanalytic  question,  it  is  plain  that  where  the  diagnosis 
is  so  in  doubt  as  in  this  instance,  proceeding  to  elaborate 
reeducation  upon  sex  lines  or  upon  other  lines  of  character 
development  would  be  very  time-consuming  from  the  stand- 
point of  the  patient  himself.     If  the  patient  is  a  cyclothymic, 


THE    KINGDOM    OF    EVILS  339 

then  he  is  likely  to  emerge  with  absolute  normality  after  a  time 
in  any  event.  If  he  is  a  psychasthenic,  at  all  events  he  has  the 
record  of  having  emerged  with  perfect  normality  from  the 
previous  attack  and  his  psychasthenia  may  itself  be  of  periodic 
or  cyclic  nature.  (It  is  well  for  the  lay  as  well  as  the  medical 
observer  to  bear  constantly  in  mind  that  cyclothymia  is  not  the 
only  mental  disease  which  is  cyclic.)  Accordingly,  for  better 
or  worse,  no  special  psychotherapy  has  been  undertaken  other 
than  that  involved  in  the  routine  social  service  contacts  by  com- 
petent and  intelligent  social  workers,  familiar  with  psychopaths 
of  various  sorts. 

Fifteen  months  after  we  first  knew  him  Fangillo  was  able 
to  take  a  position  in  the  stock  room  of  a  large  firm  with  which 
he  is  offered  a  good  prospect  of  advancement.  He  made  the 
choice  of  this  position  rather  than  a  better  paying  position  of- 
fered by  a  former  employer  because  he  felt  that  the  larger  firm 
promised  a  more  stable  future.  Now,  a  year  later,  he  is  still 
working  for  this  firm  and  beginning  to  realize  his  expectations. 

As  a  detail  of  social  service  technique,  it  may  be  remarked 
that  Fangillo  was  gotten  a  temporary  job  with  a  certain  firm 
through  the  efforts  of  a  worker  who  was  doing  special  work 
on  the  industrial  problem  of  the  psychopathic  employee.  The 
employer  said  that  he  liked  to  get  workers  from  social  agencies 
because  a  good  deal  more  was  known  about  such  workers  than 
about  the  ordinary  run  of  applicants  for  employment. 

(See  also  Appendix  A  for  the  social  record  of  this  case.) 

Hours  spent  by  ]\Iedical  record,  26  pages 

Social  record,  21  pages 
Physician,  7J/2  Social  work : 

Visits,  II 
Psychologist,   i  Interviews  at  hospital,  13 

Telephone  calls,  13 
Social  worker,  23J/2  Letters,  6 


Industrial  accident.  Traumatic  hysteria.  Compensation 
qiiestions. 

Case  90.  Dennis  O'Donnell  was  sent  to  the  hospital  by 
the  Industrial  Accident  Board.  He  had  gotten  a  number  of 
fractures,  especially  of  the  arms.  X-ray  examination  failed 
to  show  that  he  had  any  fracture  of  the  skull.     After  his  fall 


340  THE    KINGDOM    OF    EVILS 

he  was  treated  for  a  time  in  the  company  hospital,  went  home 
at  his  own  request,  and  in  the  space  of  three  months  began  to 
do  some  work  again,  though  he  was  not  very  successful  at  any 
kind  of  job.  He  left  for  a  distant  state  but  did  not  work 
there  for  some  eighteen  months.  His  left  hand  was  weak. 
Heat  and  noise  disturbed  him  greatly  in  various  factories 
where  he  tried  to  work.  The  family  had  accumulated  many 
debts  and  he  was  much  worried  about  these.  His  memory  had 
been  very  poor  since  the  accident.  He  was  a  very  quiet  and 
contemplative  sort  of  man.  He  said  that  his  hand  felt  weak 
and  this  was  verified  by  test,  but  besides  this  it  was  found  that 
he  had  a  complete  anesthesia  of  the  left  side  of  the  body  with 
deafness  in  the  left  ear  and  even  some  visual  disturbance  in  the 
left  eye.  Yet  at  the  same  time  the  reflexes  were  not  different 
upon  the  anesthetic  side  from  their  condition  on  the  right  side 
of  the  body.  The  arm  muscles  were  not  atrophic.  On  the 
whole  there  seemed  to  be  no  evidence  of  any  organic  lesion  to 
account  for  the  weakness  or  the  anesthesia. 

The  diagnosis  was  one  of  tramnatic  hysteria  which,  to  quote 
from  the  hospital  report,  is  "a  very  real  disease  and  so  far  as 
we  can  see  would  justify  compensation." 

O'Donnell  had  been  paid  after  his  accident  nine  dollars  a 
week  for  four  months  and  later  for  six  months  at  the  rate  of 
ten  dollars  a  week.  This  compensation  was  discontinued  by 
the  Accident  Board  which  felt  that  the  man's  condition  was 
due  more  to  alcohol  and  syphiHs  than  to  the  accident.  After 
seven  months'  delay  O'Donnell  was  admitted  to  the  Psycho- 
pathic Hospital  upon  the  representation  of  liis  lawyer.  The 
lawyer  was  unaware  tliat  the  patient  was  working  all  this  time. 
Four  months  later  O'Donnell  was  offered  a  sum  of  five  hundred 
dollars  as  a  lump  settlement  to  cover  unemployment.  This  sum 
O'Donnell  is  not  willing  to  take  but  says  he  has  not  the  funds 
to  contest  the  case.  In  war  times  he  earned  about  thirty-four 
dollars  a  week  but  after  being  a  patient  at  the  Psychopathic 
Hospital  he  could  not  get  this  thirty- four-dollar-a-week  job  and 
is  now  working  at  fifteen  and  eighteen  dollars  a  week  in  a 
factory. 

Perhaps  this  case  will  serve  as  well  as  any  to  indicate  the 
very  doubtful  question  of  social-service  technique  that  arises 
in  industrial  accidents.  Probably  the  question  of  syphilis 
raised  by  the  board  is  to  be  answered  in  the  negative;  at  all 


THE    KINGDOM    OF    EVILS  34I 

events  there  seems  to  be  no  evidence  of  syphilis  of  the  nervous 
system  as  a  cause  for  the  symptoms  shown.  Nor  had  there  been 
any  history  of  alcohoHsm  for  a  period  of  some  fifteen  years, 
ahhough  before  that  time  O'Donnell  had  been  alcohohc.  It 
would  seem  wise  for  O'Donnell  to  report  from  time  to  time 
to  the  out-patient  department.  There  is  always  a  question 
whether  the  advantage  of  counsel  afforded  by  the  hospital  is 
countervailed  by  the  loss  of  self-reliance  which  some  men  might 
feel  through  having  to  resort  to  a  hospital. 

Hours  spent  by  Medical  record,  21  pages 

Social  record,  15  pages 
Physician,  5  Social  work: 

Visits,   I 
Psychologist,   I  Interviews  at  hospital,  7 

Telephone  calls,  15 
Social  worker,  g^  Letters,  18 


Machinist  in  aviation  suffers  from  traumatic  hysteria  after 
blow  on  the  head. 

Case  91.  Walter  Nelson  enlisted  at  twenty  in  the  naval 
reserve,  during  the  spring  of  191 7,  and  in  the  fall  was  as- 
signed as  a  first-class  machinist  in  aviation.  While  he  was 
vvorking  on  a  plane  in  a  tent  hangar  during  a  windstorm,  the 
tent  blew  down  and  he  was  hit  by  a  pole  across  the  back  and 
head.  He  was  unconscious  for  half  an  hour  and  in  the  hos- 
pital three  days  with  weakness  and  backache.  There  were  no 
other  symptoms  at  that  time.  Two  weeks  later  he  was  among 
volunteers  accepted  for  foreign  service,  but  the  party  was  not 
sent  at  the  expected  time  and  Nelson  was  very  much  disap- 
pointed. After  this  he  became  shaky  and  excited  and  was  sent 
back  to  hospital.  He  went  home  for  a  Christmas  furlough 
and  was  not  well  enough  to  return  to  duty  at  the  end  of  his 
time.  He  seemed  to  his  family  to  be  "far-off,  hazy,  in  a 
trance"  and  "had  to  be  cared  for  like  a  child."  He  worried 
for  fear  people  would  call  him  "a  slacker." 

After  a  month  in  the  naval  hospital,  he  went  back  to  duty 
but  was  still  somewhat  dazed  and  confused.  He  wrote  his 
family  that  he  was  afraid  of  being  court-martialed  for  having 
done  some  of  his  work  wrong  and  asked  them  to  send  him 
poison  to  take.  In  the  spring  he  was  discharged  for  physical 
disability.     On  his  return  home  he  was  advised  to  come  to  our 


342  THE    KINGDOM    OF    EVILS 

out-patient  department.  He  said  that  he  felt  "dopey"  and 
changed  since  the  accident,  that  he  had  very  Httle  interest  in 
anything.  Reluctantly  he  told  of  having  a  fear  after  the  acci- 
dent that  he  had  been  cursed  by  a  young  woman  with  whom  he 
had  had  sex  relations  for  a  short  time,  (he  had  a  friend  who 
had  been  cursed  by  a  young  woman),  and  said  he  dwelt  on 
this  thought  constantly.  His  condition  was  diagnosed  as 
traumatic  hysteria. 

In  a  month  he  had  improved  slightly  and  in  another  month 
was  much  better.  In  six  months  under  the  influence  of  treat- 
ment, including  massage,  hydrotherapy,  suggestion,  tonic,  and 
light  work,  he  was  much  more  cheerful  and  animated  and  able 
to  work  three-quarters  time.  He  had  given  up  the  obsessive 
idea  of  the  young  woman's  curse  and  was  showing  steady 
improvement. 

Hours  spent  by  Medical  record,  5  pages 

Social  record,  i  page 
Physician,  4^4  Social  work  : 

Visits,  o 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  0 
Social  worker,  1J/2  Letters,  0 


Feeble-minded  soldier  discharged  for  hysteria.  Marfied  a 
prostitute  to  refonii  her. 

Case  92.  Martin  O'Hara  was  sent  to  the  hospital  by  the 
court  charged  with  indecent  assault  upon  a  six-year-old  boy 
in  the  hotel  where  he  was  working  as  janitor.  He  denied  the 
charge,  the  child  admitted  previous  knowledge  of  perverted  sex 
practices,  and  it  was  never  determined  whether  O'Hara  was 
guilty. 

He  was  twenty-nine  years  old  and  his  mental  rating  by  the 
Point  Scale  was  11.8.  At  the  age  of  twelve  he  had  run  away 
to  sea  and  spent  a  few  weeks  on  a  fishing  boat.  His  father 
would  not  let  him  go  again  to  sea  so  he  started  to  work  and 
held  countless  odd  jobs  in  theaters,  amusement  parks,  and 
circuses.  He  never  liked  to  loaf  and  when  work  was  not  to 
be  found  he  would  go  up  to  the  Maine  woods.  After  war  was 
declared  he  tried  to  enlist  and  was  rejected  because  of  bad  teeth. 
A  year  later  he  was  drafted  and  became  sick  in  camp  during 
the  trial  gas  attacks.     He  was  sent  home  for  a  rest  and  soon 


THE    KINGDOM    OF    EVILS  343 

after  discharged  from  the  service  with  the  diagnosis  hysteria. 
He  was  suffering  then  with  gastric  pain  and  vomiting  and  a 
sHght  tremor  of  the  head.  These  symptoms  disappeared  after 
a  while. 

He  went  to  work  and  in  a  few  weeks  married  a  girl  whom 
he  had  known  for  several  years.  He  said  that  he  had  known 
she  was  sexually  promiscuous,  but  that  he  had  always  treated 
her  with  the  greatest  respect  and  loved  her  devotedly.  They 
were  married  in  a  pool-room  where  he  worked,  by  a  justice 
of  the  peace.  That  same  night  he  returned  to  work  and  con- 
tinued to  work  until  midnight  so  that  he  might  get  double 
pay.  The  girl  went  to  stay  with  her  parents  that  night.  The 
following  day  he  discovered  she  had  a  six-months-old  baby, 
and  after  inquiry  he  was  forced  to  the  conclusion  that  the 
father  of  the  child  was  actually  unknown.  He  forgave  the 
girl  for  the  deception  and  wished  to  live  with  her,  "to  reform 
her,"  but  she  left  him  and  continued  to  live  as  a  prostitute. 
Both  she  and  the  baby  were  syphilitic.  He  had  never  lived 
with  his  wife  since  the  marriage. 

Under  the  excitement  of  these  events  the  tremor  had  re- 
turned. When  he  left  the  hospital  after  nine  days  he  still  had 
it,  although  at  times  it  disappeared  entirely,  especially  when 
he  was  interested  and  intent  upon  what  he  was  doing.  Later 
when  he  came  to  the  out-patient  department  he  would  some- 
times tremble  violently  but  at  other  times  would  appear  quite 
composed.  He  went  to  live  with  his  parents  and  made  up 
his  mind  to  secure  a  divorce  from  his  wife.  After  some  months 
he  felt  able  to  work  and  got  a  job. 

He  is  beginning  to  feel  strong  and  cheerful  again  and  the 
tremor  is  less  marked  and  comes  less  frequently.  He  says  that 
although  he  knew  a  good  deal  about  his  wife,  before  he  married 
her,  he  did  not  know  "half  of  it"  and  he  is  no  longer  in  love 
with  her.  He  has  worried  a  good  deal  over  being  dependent 
upon  his  parents,  who  have  no  surplus  income,  but  now  he 
feels  fit  to  maintain  himself. 

Hours  spent  by  Medical  record,  25  pages 

Social  record,  12  pages 
Physician,  4^  Social  work: 

Visits,  2 
Psychologist,   i  Interviews  at  hospital,  3 

Telephone  calls,  23 
Social  worker,  51^  Letters,  0 


344  THE    KINGDOM    OF    EVILS 

Drafted  soldier  discharged  for  physical  incapacity.  Psy- 
chasthenia.    Improvement. 

Case  93.  Joseph  Levenson  was  drafted  in  the  fall  of  191 7 
(twenty-five  years  old)  and  discharged  in  three  months  for 
physical  incapacity.  When  he  came  to  the  out-patient  depart- 
ment six  months  later  he  was  complaining  of  insomnia,  lack 
of  appetite,  and  pains  in  his  head  and  back.  He  claimed  that 
discipline  and  the  rigorous  winter  had  caused  him  a  physical 
collapse. 

On  the  theory  of  a  possible  developing  of  acromegalia,  an 
X-ray  picture  of  his  head  was  taken;  but  it  showed  nothing 
abnormal.  The  diagnosis  was  psychasthenia.  In  four  months 
he  had  made  definite  improvement  and  was  planning  part  time 
work. 

At  first  a  marked  increase  of  symptoms  occurred  when  he 
was  told  that  he  ought  to  get  to  work.  He  was  living  with  a 
devoted  family  in  a  good  home.  He  undertook  a  course  in 
salesmanship,  and  at  first  he  was  unable  to  sit  through  the 
classes  on  account  of  his  pains.  He  would  stand  it  as  long 
as  he  could  (for  about  two  hours)  and  then  stretch  out  on  a 
table  or  chairs  until  he  felt  able  to  go  on  again.  After  a  time 
he  could  sit  through  the  seven  hours  of  the  school  day  by 
relaxing  for  a  few  minutes  now  and  then.  At  this  time,  even 
after  three  months  of  treatment,  he  could  not  walk  much.  He 
said  once  he  thought  he  could  never  "bear  it  and  live"  but  now 
he  knew  he  "had  it  in  him"  and  could  "look  forward  happily 
to  the  future."  Later  on  he  had  a  plan  for  starting  a  provision 
store  of  his  own  if  the  Red  Cross  would  make  him  a  loan;  but 
this  was  decided  to  be  an  insecure  investment.  Levenson  then 
got  a  position  as  salesman  in  a  meat  market.  He  works  full 
time  and  is  improving,  though  he  still  suffers  from  pain  and 
weakness. 

Hours  spent  by  Medical  record,  5  pages 

Social  record,  5  pages 
Physician,  4  Social  work : 

Visits,  3 
Psychologist,  o  Interviews  at  hospital,  3 

Telephone  calls,  12 
Social  worker,  3J/2  Letters,  o 


PSYCHOPATHIC  PERSONALITY 


IN  A  WOMAN  TYPESETTER,  28 


1915 
Inebriety 

Insufficient  Income 
Non-support  of  Mother 
Family  Discord 
Friendlessness 
Lying 
Fabrication 
Suicidal  Attempt 


ic)i6 
No  Alcohol 
Adequate  Wages 
Contributions  to  Mother 
Away  from  Home 
Companionship 
No  Lying 
Slight  Fabrication 
Cheerfulness 


SECTION  XI 

PSYCHOPATHOSES  (DUBIOUS  AND  SPECIAL  PSYCHOPAtHlAS) 

Psychopathic  personality.  Typesetter,  sickly,  unhappy,  un^ 
popular,  discouraged,  attempted  suicide.  Trained  to  be  self- 
sustaining.  Psychiatric  social  work.  Many  workers  on  the 
case. 

Case  94.  There  is  much  discussion  as  to  the  meaning  of 
the  term  "psychopathic  personaHty."  Whereas  in  one  sense 
every  victim  of  mental  disease  shows  effects  in  his  personality, 
the  effects  by  the  same  token  require  psychiatric  social  atten- 
tion even  if  the  victim  have  brain  tumor.  The  term  has  come 
to  be  used  for  many  forms  of  usually  rather  slighter  mental  dis- 
eases than  those  which  receive  more  definite  designations  as 
belonging  to  well-defined  disease  entities.  Possibly  the  term 
being  briefer  and  smoother  is  theoretically  better  than  the  term 
"constitutional  psychopathic  inferiority."  But  the  latter  term 
has  been  worked  into  sundry  official  documents,  and  it  is  to 
be  feared  we  shall  have  it  with  us  for  some  decades  and  until 
a  greater  definition  of  the  whole  topic  of  psychopathic  per- 
sonalities shall  occur.  According  to  one  group  of  thinkers 
every  psychopath,  and  especially  every  victim  of  psychopathic 
personality,  is  practically  sui  generis;  that  is  to  say,  has  a  most 
highly  individualized  and  specialized  make-up  of  soil  and  taint. 
Nor  does  it  do  any  harm  to  insist  upon  this  ultra-individualism 
in  diagnosis  and  treatment,  as  it  practically  comes  up  in  the 
clinic.  According  to  other  authors  there  threaten  to  break  out  in 
the  group  of  the  psychopathic  personalities  sundry  subgroups. 
One  of  these  formulations  was  made  a  special  study  of  by  the 
former  Chief  of  Staff,  Dr.  H.  M.  Adler,  at  the  Psychopathic 
Hospital.  It  is  mentioned  in  greater  detail  in  the  summary. 
Perhaps  as  valuable  a  statement  as  any  general  statement  can 
now  be  concerning  these  personalities  runs  to  the  effect  that 
the  victims  are  to  some  extent  infantilistic.     Some  of  the  per- 

347 


348  THE    KINGDOM    OF    EVILS 

sonalities  are  a  little  infantile  along  the  line  of  their  emotions. 
These  are  likely  to  belong  to  a  group  with  hysterical  trend. 
Others  show  more  or  less  childlike  obstinacy  and  episodic  over- 
reactions  to  ordinary  stimuli,  recalling  effects  in  certain  chil- 
dren. Some  cases  seem  to  represent  enormous  exaggerations 
of  particular  instincts  and  are  given  to  wandering,  to  special 
types  of  sex  activity  and  the  like.  Possibly  some  alcoholics 
may  be  regarded  as  weak  of  will  in  the  direction  of  psycho- 
pathic personality,  so  that  alcoholic  mental  diseases  cannot 
be  set  down  as  directly  and  proportionately  due  to  their 
alcoholism. 

Harriet  Farmer  was  not  at  all  feeble-minded ;  in  fact  tests 
at  intervals  of  two  years  showed  that  she  was  making  a  proper 
improvement  to  test.  Let  us  take  occasion  to  insist,  however, 
that  not  seldom  the  selfsame  psychopathic  traits  do  occur  in 
morons  or  other  subnormal  persons.  We  did  not  have  to  face 
in  the  Farmer  case  the  lack  of  judgment  characteristic  of  a 
moron. 

Harriet  was  certainly  an  average  scholar  and  indeed  read 
much  good  classical  literature.  Twenty-eight  upon  her  first 
contact  with  the  hospital,  she  had  been  for  two  years  very  alco- 
holic, not  infrequently  drinking  alone.  She  had  also  been  un- 
truthful and  unreliable;  she  told  scandals  about  a  priest;  told 
of  mistreatment  by  her  family;  and  made  up  stories  about  the 
attentions  of  men  to  her.  Harriet  was  rather  talkative  and 
aggressive  with  people  with  whom  she  came  in  contact.  Church 
club  members  did  not  want  to  see  her  at  the  club.  At  home 
she  was  lazy,  slovenly,  and  thoughtless.  She  lay  in  bed  late  and 
expected  her  mother  and  sister  to  sew  and  wash  for  her. 

It  was  discovered  that  her  father  died  of  general  paresis ; 
her  mother  was  also  treated  for  many  years  for  syphilis  which 
she  had  contracted  from  Flarriet's  father.  The  girl  herself  was 
short,  slight,  pale — the  so-called  wiry  type,  rather  unattractive, 
possibly  anemic,  and  with  bad  teeth.  She  came  to  the  hospital 
after  an  attempt  at  suicide,  which  attempt  was  made  a  day 
when  nothing  at  all  unusual  had  been  noticed  in  her  behavior. 
She  had  been  at  times  depressed  at  menstrual  periods,  but  there 
had  at  this  time  been  no  depression.  She  had  lunched  with 
her  mother,  who  a  few  hours  later  was  notified  that  paris  green 
had  been  taken  by  Harriet.  Harriet  said  she  had  originally 
bought  the  paris  green  for  plant  insects.     She  had  taken  it 


THE    KINGDOM    OF    EVILS  349 

feeling  discouraged  with  her  Hfe  and  with  the  poor  physical 
condition  of  her  mother. 

The  psychiatrists  found  her  practically  negative  in  every 
respect.  Even  anemia  was  found  to  be  not  present.  Psychiat- 
rically  nothing  abnormal  could  be  found  beyond  the  provisional 
diagnosis  "manic  depressive"  suggested  by  some  observations. 
She  clearly  was  not  committable.  As  for  a  motive  for  suicide, 
a  somewhat  curious  history  transpired.  She  had  put  her  name 
and  address  in  a  candy  box  and  had  gotten  up  a  correspond- 
ence— "object  matrimony" — with  a  man  who  turned  out  to 
be  sixty-five  years  of  age  and  otherwise  ineligible.  This  episode 
appears  to  have  helped  her  to  think  that  there  was  nothing  left 
for  her  in  life.  There  had,  of  course,  been  considerable 
pecuniary  trouble  in  the  family.  The  two  brothers  had  mar- 
ried and  were  no  longer  able  to  help  the  family.  The  parents 
had  been  separated  when  Harriet  was  eight  years  of  age. 

After  a  month's  observation  the  determined  diagnosis  was 
"not  insane,  not  feeble-minded — psychopathic  personality." 
Harriet  has  now  for  some  years  been  under  pretty  continuous 
observation  by  the  social  service.  After  a  period  of  some  two 
and  one-half  years  she  was  so  compensated  or  adapted  to  life 
as  to  require  little  aid.  During  this  period  of  two  and  one- 
half  years  a  rather  intensive  type  of  social  work,  supported  by 
medical  consultations,  was  carried  out.  The  psychiatrist's 
general  recommendation  was  that  a  good  deal  more  variety  in 
life  was  necessary.  It  was  the  task  of  the  social  worker  to 
secure  such  variety  and  to  make  changes  in  her  living  and 
working  arrangements  before  she  should  get  stale.  It  was  ar- 
ranged that  she  should  live  away  from  home,  and  in  the  house 
where  she  lived  she  now  began  to  make  girl  friends  after  a 
fashion  which  had  been  quite  unknown  to  her  before.  The 
other  girls  liked  her.  Exercise,  diet,  and  bathing  became  sys- 
tematic. Menstrual  difficulties  were  discussed  with  women 
physicians  at  the  hospital.  She  stopped  drinking  and  ceased 
to  mention  suicide.  She  no  longer  told  out-and-out  lies  and 
the  tendency  was  represented  for  the  most  part  by  exaggera- 
tions or  slight  perversions  of  the  facts. 

From  time  to  time  she  became  discouraged  and  made  vari- 
ous complaints,  apparently  fearing  she  was  "to  be  put  away." 
But  these  spells  of  bitterness  were  transient  and  left  her  with, 
her  usual  friendliness.     She  began  to  have  a  number  of  dif- 


350  THE    KINGDOM    OF    EVILS 

ferent  suitors  and  went  walking  with  them  and  took  meals  at 
hotels  and  dairy  lunches  with  them.  Harriet  very  gladly  ap- 
peared at  the  clinic  for  social  workers  and  told  her  story  in  an 
approximately  correct  and  engaging  fashion.  The  experienced 
social  worker  is  apt  to  say,  "Why  this  sort  of  thing  is  just  what 
every  social  worker  has  to  deal  with !"  We  are  far  from  deny- 
ing that  such  is  the  case.  We  hold  that  statistics  of  medical 
social  workers  will  probably  show  that  practically  one  case  in 
two  of  all  intensively  studied  medical  social  cases  will  turn  out 
to  be  in  some  important  way  psychiatric.  If  such  commentary 
means  to  argue  that  psychiatric  social  work  is  unnecessary  as  a 
specialty,  just  because  psychiatric  social  cases  are  so  frequent 
that  every  social  worker  has  met  them,  then  we  should  be  com- 
pelled to  decline  to  follow  the  argument.  One  of  two  conclu- 
sions, and  we  hold  that  both  conclusions,  can  be  drawn  from 
this  state  of  afifairs,  namely :  First,  that  instruction  in  social 
psychiatry  should  be  given  to  every  medical  social  worker; 
second,  that  there  should  be  specialized  training  to  develop 
specialized  psychiatric  social  workers. 

It  seems  to  us  that  the  amount  of  personality  study  required 
for  the  diagnosis  of  Harriet  Farmer  and  the  amount  of  per- 
sonal adjustment  required  would  mean  that  there  must  be  in 
the  world  a  gro.up  of  specializing  psychiatric  social  workers. 
Many  medical  social  workers  are  by  temperament  unfit  for 
psychiatric  social  work,  or  at  all  events  not  as  well  fitted  as 
are  others.  It  is  also,  we  believe,  going  to  be  held  that  all  social 
workers  whether  medical  or  non-medical  ought  to  be  given 
psychiatric  training  of  some  sort.  It  would  be  hard  to  show 
convincingly  the  extraordinary  change  in  Harriet  Farmer  from 
the  unsociable,  pallid,  unattractive  girl,  with  rather  a  bitter  out- 
look on  life,  to  the  competent,  self-supporting,  physically  much 
improved,  rather  pleasing  cooperative  girl  with  a  normal  set 
of  outlets  along  all  of  the  main  social  lines. 

Too  much  and  too  little  can  be  made  of  the  so-called  per- 
sonal relation  between  some  one  individual  therapeutist  and 
the  patient.  The  slogan  "individualization"  is  often  taken  to 
mean  that  there  should  be  in  the  ideal  a  one-to-one  correspond- 
ence between  the  social  agent  and  the  social  patient.  It  is  true 
that  many  effects,  especially  in  the  field  of  alcoholism,  are 
gained  in  this  manner.  But  individualized  treatment  is  not 
necessarily,  or  as  a  rule  even  possibly,  the  treatment  of  one  in- 


THE    KINGDOM    OF   EVILS  35 1 

dividual  by  one  individual.  We  do  not  need  to  paraphrase  Lin- 
coln by  saying  social  treatment  is  treatment  of  an  individual, 
by  an  individual,  and  for  an  individual.  Treatment  is  as  often, 
and  perhaps  always  should  be,  the  treatment  of  all  the  indi- 
viduals in  a  given  family — each  individual  taken  as  such.  The 
individualization  of  treatment  does  not  refer  to  carrying  all 
of  the  measures  up  to  one  head.  There  is  a  certain  democracy 
in  social  treatment,  the  advantages  of  which  have  not  been 
sufficiently  preached.  In  the  case  of  Harriet  Farmer,  for  in- 
stance, although  two  social  workers  not  trained  in  psychiatry 
had  failed  to  make  proper  contacts  with  her  personality,  yet 
after  the  Psychopathic  Hospital  contact  was  made  the  social 
treatment  of  Harriet  was  carried  out  by  not  less  than  six  social 
•workers  of  various  temperaments,  who  nevertheless  all  suc- 
ceeded in  aiding  the  development  of  Harriet's  character  with 
its  consequent  stoppage  of  drinking  and  bitterness.  There 
were  also  four  physicians  more  or  less  intimately  concerned 
with  the  case. 

Of  course  what  Harriet  did  was  in  some  sense  to  personify 
the  entire  Psychopathic  Hospital  and  to  consider  herself  under 
its  auspices.  This  relation  is  by  no  means  uncommon,  nay, 
perhaps,  is  the  usual  one.  The  hospital  with  its  medical  and 
social  officers  becomes  a  sort  of  religion  with  the  patient.  No 
hospital  run  under  what  we  are  sometimes  tempted  to  term 
"regular-army"  regulations  can  become  a  religion  with  such 
patients.  H  the  social  workers  were  suddenly  removed  from 
the  institutions,  the  chances  are  that  a  patient  of  this  type 
would  not  return  to  the  hospital  more  than  once. 

There  is  a  certain  uniqueness  about  this  psychopathic  hos- 
pital relation  with  its  patients  which  stands  out  in  sharp  relief 
against  the  "borrow-no-trouble"  attitude  of  the  old-style  in- 
stitutions for  the  committable  insane. 

(See  also  Appendix  A  for  the  social  record  of  this  case.) 

Hours  spent  by  Medical  record,  41  pages 

Social  record,  55  pages 
Physician,   5^  Social  work  : 

Visits,  76 
Psychologist,  2  Interviews  at  hospital,  16 

Telephone  calls,  50 
Social  worker,  150  Letters,  14 


35^  THE    KINGDOM    OF    EVILS 

Son  of  an  educated  Belgian  family.  Wanderer  and  irregular 
worker. 

Case  95.  Louis  Sand,  the  son  of  a  Belgian  professional 
man,  was  twenty-eight "^years  of  age,  an  immigrant,  upon  a 
rather  irregular  allowance  from  his  father.  He  had  spent  time 
in  twelve  different  states  during  five  years,  working  here  and 
there  for  a  few  weeks  or  months  at  factory  or  farm  work.  In 
fact  he  had  made  eighteen  changes  from  one  place  to  another 
and  had  borrowed  small  sums  of  money  here  and  there.  He 
spent  much  of  his  time  looking  for  work  and  reading.  He 
had  the  ambition  to  take  courses  in  engineering  and  had  had 
some  college  work  in  Belgium.  There  was  no  language  diffi- 
culty since  he  spoke  and  wrote  English  fluently.  It  was  thought 
he  was  a  victim  of  Meniere's  disease — one  ear  was  growing 
deaf  and  he  was  dizzy. 

Sand  never  became  a  house  case  at  the  Psychopathic  Hos- 
pital but  was  immediately  left  to  the  social  service  after  his 
coming  on  his  own  initiative  to  the  out-patient  department. 
Some  loans  were  made  to  him  which  he  came  back  from  time 
to  time  to  pay.  Nine  months  after  the  first  observation  he  was 
found  a  position  with  an  engineering  firm  which  he  held  for 
some  four  months  and  was  taking  a  correspondence  course 
in  the  general  topic.  The  case  was  accordingly  closed.  How- 
ever, Sand  began  to  feel  restless,  wrote  appealing  letters  to 
the  social  service  telling  about  lack  of  will  power — his  desire 
to  get  back  to  Belgium.  The  case  was  accordingly  reopened 
by  the  social  service  and  work  was  secured  for  him  in  new 
places.  He  gave  the  visitor  a  sum  of  money  which  was  put 
in  the  bank  for  him,  a  nasal  operation  was  performed,  and 
new  lenses  for  his  glasses  were  gotten  for  him.  He  then  left 
for  a  distant  state. 

Sand,  although  he  desired  to  return  to  Belgium,  was  ashamed 
to  go  until  he  had  made  good  in  America.  He  had  no  friends 
or  associates  with  persons  of  his  own  educational  level.  He 
talked  a  good  deal  of  his  interest  in  books  and  in  music,  but 
these  interests  proved  to  be  superficial.  He  had  not  rationalized 
his  relations  with  women,  affecting  refinement  and  chivalry  on 
the  one  hand,  on  the  other  hand  resorting  to  masturbation. 
He  had  a  shell  of  ambition  with  apparently  little  power  behind 
it.     Perhaps  he  is  to  be  classed  as  a  sort  of  constitutional  in- 


THE    KINGDOM    OF    EVILS  353 

ferior,  inasmuch  as  the  disorder  or  defect  is  particularly  one 
of  will.  If  we  were  asked  for  a  single  phrase  for  him,  it  would 
be  hypobulic.  Hypobulics  no  doubt  require  the  social  worker 
and  the  physician  to  act  more  as  mental  splints  than  in  any 
other  definable  way. 

Our  Belgian  correspondence  concerning  Sand  shows  that  he 
had  been  as  unsuccessful  there  and  weak  of  will  as  he  was  here. 
What  is  to  be  the  outcome  of  his  Meniere's  disease,  if  that  be 
the  correct  diagnosis?  No  one  can  say,  but  Sand  is  going 
to  keep  in  touch  with  the  Life  Extension  Institute,  whose 
examiners  will  no  doubt  trace  the  further  effects  if  any  of  the 
aural  condition. 

Hours  spent  by  Medical  record,  13  pages 

Social  record,  25  pages 
Physician,  s%  Social  work  : 

Visits,  II 
Psychologist,  o  Interviews  at  hospital,  27 

Telephone  calls,  30 
Social  worker,  43^  Letters,  30 


Child  of  a  thief  and  a  prostitute;  brought  up  by  charity. 
Psychopathia  sexualis. 

Case  96.  An  interest  was  taken  in  Theresa  Beauvais  by  a 
lady  who  had  lived  in  the  town  where  Theresa  was  born. 
Theresa's  father  was  a  professional  thief  and  her  mother  had 
been  a  prostitute.  Theresa  herself  had  already  entered  upon 
this  life  and  was  in  the  poor  house  when  her  townswoman 
found  her.  When  Theresa  at  fourteen  had  learned  the  dangers 
of  pregnancy,  she  had  stopped  promiscuous  intercourse  and 
begun  mxasturbation.  Theresa  never  tried  to  conceal  her  life 
or  habits  and  a  psychoanalyst  who  saw  her  said  that  as  there 
was  nothing  repressed,  psychoanalysis  was  superficial.  Be- 
sides, she  was  rather  unintelligent  or  at  all  events  looked  so. 
(She  later  tested  at  I5>4  years  by  Stanford-Binet  and  by  Point 
Scale  as  17.5,  accordingly  probably  not  at  all  feeble-minded.) 
Although  unintelligent-looking  she  made  a  very  good  general 
impression  and  was  well  liked.  She  had  studied  in  an  academy 
for  some  years  but  had  not  finished  her  work. 

She  was  observed  at  the  Psychopathic  Hospital  and  finally 


354  THE    KINGDOM    OF    EVILS 

regarded  as  a  case  of  psychopathic  personaHty,  though  a  ques- 
tion of  psychoneurosis  and  a  question  of  dementia  praecox 
had  also  been  raised.  She  was  found  to  be  abnormally  senti- 
mental and  somewhat  dramatic  in  her  attitude  toward  her 
delinquency.  She  seemed  rather  to  enjoy  making  an  impres- 
sion upon  the  maids  and  nurses  with  details  of  how  bad  she 
had  been  and  the  things  she  had  undergone.  She  was,  how- 
ever, on  the  whole,  fairly  truthful.  She  said  that  she  could 
not  control  herself  with  respect  to  sex  relations.  (There  was 
a  history  of  absolute  promiscuity  for  a  period  of  some  three 
months  before  admission  to  the  hospital.)  Amongst  the  psycho- 
pathic personalities  there  are,  no  doubt,  a  number  of  cases  of 
psychopathia  sexualis  and  amongst  these  a  form  called  satyriasis 
to  which  Theresa  may  belong,  but  of  course  that  designation 
does  not  afford  much  information  as  to  prognosis  or  treatment. 

She  had,  ten  months  before  admission,  started  learning  to 
be  a  nurse  and  after  her  discharge  from  the  hospital  she  was 
placed  as  a  ward  maid  in  a  hospital  where  she  stayed  three 
months.  She  there  had  sex  relations  with  an  employee  who 
talked  of  marrying  her  but  had  trachoma  and  was  in  general 
unreliable.  The  marriage  was  accordingly  discouraged.  She 
then  got  work  in  mills  for  short  periods,  refusing  to  room  in 
a  girls'  boarding  house,  disappeared  from  view  for  a  fort- 
night, and  then  telephoned  that  she  had  become  a  maid  in  a 
questionable  lodging  house.  Then  she  was  brought  by  the 
police  to  the  hospital  again.  This  was  six  and  a  half  months 
after  her  discharge  from  the  hospital.  It  transpired  that  she 
had  been  living  with  a  sailor  who  had  forsaken  her.  She  had 
shown  odd  conduct,  going  out  two  days  in  succession  with  her 
hair  down,  moccasins  on  her  feet,  and  a  coat  over  her  shoulder, 
returning  exhausted  and  (by  her  own  story)  confused.  There 
was  also  a  spell  of  screaming  and  she  was  picked  up  by  the 
police  sitting  on  a  doorstep.  The  diagnosis  of  psychopathic 
personality  was  again  made. 

After  discharge  she  was  put  to  work  in  a  mill  and  made  to 
live  in  a  very  good  boarding  house  for  working  girls.  She 
talked  about  taking  a  fresh  start,  yet  within  two  months  she 
was  found  to  be  pregnant  and  was  sent  to  a  maternity  home 
where  there  was  a  miscarriage.  She  now  went  to  work. in  a 
professional  man's  family  near  by  and  actually  took  full  re- 
sponsibility for  his  house  during  his  wife's  illness.     She  stayed 


THE    KINGDOM    OF    EVILS  355 

there  eight  months.  She  had  been  found  to  have  a  positive 
Wassermann  test  with  the  serum  and  was  receiving  treatments 
weekly.  After  a  trip  to  the  hospital  for  such  treatment  she 
failed  to  return  to  her  working  place.  About  six  weeks  later 
an  officer  of  her  maternity  home  met  her  on  the  street.  She 
said  that  she  had  been  living  as  a  street-walker  and  resorting 
to  masturbation  constantly.  Sent  to  another  hospital  for 
syphilitic  treatment  she  ran  away  six  weeks  later,  was  found 
again  and  returned  in  a  few  days  and  again  discharged.  After 
further  hospital  treatment  in  another  hospital  she,  two  months 
later,  took  another  job  in  a  mill  and  a  pleasant  room  in  a  good 
lodging  house  was  arranged  for  her.  She  was  interested  in 
her  work  but  was  slow  in  learning  the  trade.  She  was  easily 
discouraged.  She  kept  in  close  touch  with  the  social  worker 
but  had  spells  of  being  inaccessible  and  almost  antagonistic. 
She  grew  tired  of  her  factory  work  and  a  position  was  found 
for  her  as  nursemaid  to  care  for  a  semi-paralyzed  woman. 
She  was  pleased  with  her  new  position  and  was  very  hopeful 
about  her  future. 

Very  soon  she  entered  into  sexual  relations  with  a  man  living 
in  the  same  apartment  house,  whom  she  had  met  in  the  hall- 
way. She  left  her  position  in  a  few  months  and  made  plans 
to  go  to  New  York  with  another  patient,  Bertha  Greenwood 
(case  lo).  Bertha,  however,  weakened  and  telephoned  anony- 
mously to  the  social  worker  about  the  proposed  trip;  so  that 
Theresa  was  intercepted  and  persuaded  not  to  go.  She  was 
found  to  be  in  need  of  hospital  treatment  for  gonorrhea.  In 
the  end  an  operation  was  necessary.  While  she  was  in  a  con- 
valescent home,  she  expressed  gratitude  and  afifection  toward 
the  social  workers  for  the  care  she  had  received  from  them',, 
but  insisted  that  she  wanted  "complete  independence.."'  Iiii 
spite  of  her  desire  to  work  in  a  factory  and  live  i-n  a  lodgings 
house,  she  was  persuaded  to  take  a  more  sheltered  position  in^ 
housework. 

Such  hypersexuals  as  Theresa  are  pathetic  figures.  Aside 
from  the  hypersexuality,  a  girl  like  Theresa  may  make  an 
excellent  impression  and  we  have  letters  about  her  ambitious 
although  not  brilliant  school  work,  her  interest  in  church  affairs 
and  the  general  esteem  in  which  she  would  be  held  for  months 
at  a  time.  We  must  remember  in  particular  the  skill  and 
fidelity  which  she  showed  in  the  professional  man's  family  as. 


356  THE    KINGDOM    OF    EVILS 

above  noted.  The  sex  instinct  must  be  thought  of  as  some- 
how standing  out  in  relief  against  a  pretty  normal  background 
of  the  other  instincts.  It  is,  perhaps,  a  considerable  achieve- 
ment that  these  cases  are  now  considered  examples  of  Morbi 
rather  than  of  Vitia.  The  entire  attitude  of  the  world  to 
morbid  hypersexuals  must  be  naturally  different  from  the  atti- 
tude toward  the  sexually  immoral.  Sometimes  it  seems  that 
these  frequent  social  diagnoses,  "immorality/'  ought  to  be  re- 
placed with  some  other  diagnosis,  since  from  time  to  time  im- 
morality is  made  to  cover  some  psychopathic  hypersexuals  like 
Theresa.  Yet  the  psychiatrist  would  feel  a  great  deal  more 
comforted  could  he  advocate  a  special  treatment  of  hyper- 
sexualis.  An  artificial  menopause  by  X-ray  often  seems  a  bit 
over  vehement,  at  least  as  routine  treatment. 

Hours  spent  by  Medical  record,  47  pages 

Social  record,  51  pages 
Physician,  9  Social  work  : 

Visits,  46 
Psychologist,  2  Interviews  at  hospital,  13 

Telephone    calls,   86 
Social  worker,  84  Letters,  24 


Family  known  to  thirteen  social  agencies.  Mixed  marriage: 
marital  discord.  Oittljursts  of  temper:  assault:  arrest:  proba- 
tion.    Border-line  psyclwpatJi. 

Case  97.  The  showing  of  social  "symptoms"  (factors  and 
phenomena)    in  Leon   Blumer  was  by  the  card-catalogue .  as 

follows  : — 

Social  syrnptoms: 
Outbursts  of  temper 
Assault 

Marital  discord 
Arrest 
Probation 
Insufficient  income 

Social  diagnosis: 
Family  dissension 


THE    KINGDOM    OF    EVILS  357 

Analyzing  by  forms  of  evil  shown  we  find  provisionally: 

Medical — nothing;  possibly  family  discord,  outbursts  of 
temper,  and  assault  on  wife  mean  something  psychopathic. 

Educational — nothing;  insufficient  income  possibly  due  to 
language  difficulty? 

Moral — family  discord,  outbursts  of  temper  and  assault  (if 
not  fundamentally  psychopathic). 

Legal — arrest ;  probation. 

Economic — insufficient  income  (language  difficulty?). 

We  can  easily  dispose  of  the  language  question.  Blumer 
speaks  English,  rates  14  years  psychometrically,  and  gives  the 
impression  of  being  fairly  intelligent.  Blumer  had  married  at 
twenty  a  Nova  Scotian  Protestant  girl.  This  marriage  may 
have  been  due  to  bad  judgment,  but  there  are  perhaps  no 
eugenic  principles  well  established  enough  to  speak  against  a 
Caucasian-Semitic  crossing. 

A  Malthusian  argument  is  possible.  There  were  nine  preg- 
nancies in  ten  years.  Blumer  was  a  salesman  earning  from 
twenty  to  thirty  dollars  a  week.  The  family  income  was  in- 
sufficient. Advocates  of  birth-control  might  use  such  a  situa- 
tion to  point  a  Malthusian  moral.  But  insufficient  income 
would  never  by  itself  have  led  to  assault  and  arrest,  nor  would 
Blumer  on  the  basis  of  insufficient  income  alone  ever  have 
appeared  at  the  Psychopathic  Hospital. 

Yet,  mirabile  dicfu,  the  family  was  known  to  thirteen  chari- 
table agencies.  Quarrels  began  soon  after  marriage.  Children 
had  been  placed  out  for  years.  The  wife  broke  up  the  home 
repeatedly.  As  a  rule  the  different  agencies  were  consulted 
on  account  of  the  marital  difficulties  (sometimes  for  children's 
health,  once  for  financial  relief). 

There  the  situation  stood.  Even  our  own  social  service  let 
the  social  diagnosis  stand  at  family  dissension.  Our  orderly 
analysis  by  forms  of  evil  clarifies  the  issue,  if  it  does  not  solve 
it.  The  issue  is  moral  versus  medical  at  bottom.  Racial  mis- 
cegenation is  not  yet  to  be  conceded  an  error.  The  legal  diffi- 
culties are  plainly  secondary  to  whatever  underlies  the  out- 
bursts of  temper.  The  economic  straits  of  the  family  might 
have  been  material  for  dissension,  not  its  adequate  cause. 

Let  us  examine  the  medical  situation.  To  the  offhand  ob^ 
server  Blumer  had  himself  well  under  control.  He  readily 
admitted  his  quarreling,  but  said  he  did  not  know  whether 


358  THE    KINGDOM    OF   EVILS 

his  wife  or  the  general  situation  at  home  irritated  him  most. 
He  was  rather  emaciated  and  proved  to  have  a  pulmonary 
tubercle  on  one  side  (he  now  was  thirty  years  of  age). 

It  was  further  found  that  he  had  had  gonorrhea  at  seventeen 
and  had  at  some  time  acquired  syphilis  (positive  serum  test  first 
at  twenty-eight). 

The  wife  appeared  normal  and  enlisted  general  sympathy 
amongst  the  agencies.  Her  husband  was  sent  to  the  Psycho- 
pathic Hospital  by  one  of  these  agencies  in  the  fourth  year 
of  the  marriage  to  see  whether  there  was  a  psychopathic  basis 
for  the  marital  discord.  But  neither  feeble-mindedness  nor 
frank  mental  disease  nor  a  milder  psychopathy  could  at  that 
time  be  determined. 

It  is  the  same  today :  tests  and  observations  fail  to  prove 
mental  disease  or  defect,  though  they  do  give  a  definite  medical, 
though  non-psychiatric,  background  for  the  increasing  temper- 
amental difficulty.  Discounting  early  sex  irregularity,  mixed 
marriage,  and  a  possibly  fundamental  overirritableness  as  not 
proving  psychopathia  either  alone  or  together,  we  can  still  see 
the  value  to  the  court  of  thinking  about  Blumer  as  a  medical 
case.  If  his  difficulty  is  essentially  moral,  nevertheless  there 
will  inevitably  be  something  medical  to  do. 

But  what  is  a  moral  case?  By  classifying  a  major  group  of 
evils  as  Vifia,  we  do  not  explain  the  nature  of  Vitia.  The 
medical  urge  is  to  make  Morbi  of  all  Vitia  forthwith.  That 
decision  would  lead  to  nothing  practical.  There  is  a  certain 
proportionality  between  Blumer's  bad  conduct  and  the  compli- 
cation and  duration  of  his  domestic  difficulties.  Disease  does 
not  so  nicely  proportion  causes  and  results.  There  is  no  doubt 
a  strong  moral  element  in  Blumer's  plight,  whence  we  may 
probably  infer  an  improvement  by  training  and  by  guidance 
in  the  future. 

Thus  we  must  leave  Blumer  himself  scientifically  unresolved. 
But  it  is  plain  that  much  of  value  to  his  family  has  been  brought 
out.  The  family  syphilis  question  must  be  answered.  The 
tuberculosis  yields  some  indications.  Next  time  Blumer  ap- 
pears in  the  Psychopathic  Hospital,  further  progress  may  be 
made  in  the  deep-lying  temperament  matter.  We  cannot  rid 
ourselves  of  the  suspicion  that  we  deal  with  a  border-line 
psychopath. 


THE    KINGDOM    OF    EVILS  359 

Hours  spent  by  Medical  record,  35  pages 

Social  record,  2  pages 
Physician,  4I/2  Social  work: 

Visits,  I 
Psychologist,   i  Interviews  at  hospital,  I 

Telephone  calls,  2 
Social  worker,  3^  Letters,  7 


Psychopathic  boy  enlisted  in  the  navy:  discharged  after 
pneumonia.     Sick  and  ''nervous." 

Case  98.  Word  came  from  a  neighbor  in  Francis  Cor- 
coran's  home  town :  "The  less  said  about  him  the  better.  If 
he  would  go  to  work  as  the  other  boys  in  town  have  done,  he 
might  be  a  help  to  his  mother."  The  mother  is  a  neurotic, 
hard-working  woman,  who  is  taking  boarders  to  support  the 
family  through  the  father's  illness.  The  severity  of  our  corre- 
spondent's judgment  of  this  nineteen-year-old  lad  might  be 
moderated  if  she  knew  that  the  physicians  at  the  Psychopathic 
Hospital  found  him  to  be  a  person  of  constitutional  psycho- 
pathic inferiority  suffering  from  nephritis  and  possibly  from 
pulm,onary  tuberculosis. 

He  was  sent  from  a  public  health  hospital,  where  he  had 
been  under  treatment  for  his  physical  condition,  because  he  was 
"nervous."  had  "attacks  of  depression,"  and  "could  not  keep 
from  telling  lies."  He  told  many  yarns  about  himself,  among 
them  the  story  that  he  was  a  student  at  the  Harvard  Medical 
School.  He  explained  that  he  wanted  to  get  in  to  see  the 
operations  at  the  hospital  and  thought  he  would  be  admitted 
if  he  were  a  medical  student.  After  telling  the  doctor  in  the 
public  health  hospital  a  number  of  contradictory  fanciful  tales, 
he  later  came  to  him  to  admit  the  falsehoods,  saying  that  he 
had  just  "realized"  what  he  had  been  doing.  He  said  that  he 
felt  a  force  that  compelled  him  to  tell  extravagant  stories  and 
to  do  things  that  he  did  not  mean  to  do,  such  as  walking  the 
streets  until  one  o'clock  in  the  morning. 

Corcoran  was  disabled,  nine  months  after  his  enlistment  in 
the  navy,  through  exposure  on  transport  duty  and  sent  to  a 
hospital  with  lobar  pneumonia.  He  was  discharged  after 
fifteen  months  in  the  service.     He  went  home  for  a  while,  and 


360  THE    KINGDOM    OF    EVILS 

then  came  to  Boston  to  enter  a  business  school.  He  had  done 
rather  poorly  in  school.  He  had  entered  high  school  at  fifteen 
but  had  left  almost  immediately.  After  a  few  weeks'  study  in 
Boston,  he  got  nervous  and  discouraged  and  resorted  to  the 
pubHc  health  hospital.  He  was  advised  to  return  there  for 
further  physical  building-up. 

Hours  spent  by  Medical  record,  14  pages 

Social  record,  i  page 
Physician,  3^4  Social  work : 

Visits,  o 
Psychologist,  i  Interviews  at  hospital,  3 

Telephone  calls,  3 
Social  worker,  3  Letters,  0 


Orchestra-player  drafted.  Sergeant  in  the  band.  Gave  out 
in  camp. 

Case  99.  From  flute-player  in  a  symphony  orchestra  to 
band  sergeant  in  a  military  camp  proved  a  change  too  severe 
for  the  endurance  of  Manuel  Giordani.  As  a  boy  in  Italy  he 
had  been  allowed  to  stay  at  home  instead  of  being  apprenticed 
to  a  tailor,  doing  odd  jobs  and  studying  the  flute.  When 
he  was  seventeen  he  came  to  America,  and  by  playing  at  sum- 
mer resorts  earned  enough  to  study  music  during  the  winter, 
until  he  had  attained  a  position  in  a  first-rate  orchestra.  He 
was  drafted  when  he  was  thirty  and  was  quickly  made  sergeant. 
The  life  was  rather  hard  o  him  because  he  was  not  used  to 
active  physical  exercise,  but  he  liked  it. 

Sometimes  he  would  have  to  play  almost  continuously  from 
morning  to  night.  One  day  after  the  band  had  been  away  from 
camp  playing  nearly  all  day,  the  sergeant  remembers  that  he 
was  tired  and  had  a  feeling  of  uneasiness  and  timidity.  He 
went  past  his  station  and  started  to  walk  back  along  the  high- 
road until  an  officer  in  a  motor  picked  him  up.  He  did  not 
sleep  well  that  night  and  the  next  day  after  a  cross-country 
race  felt  exhausted  in  the  evening.  He  could  not  sleep  and  in 
the  morning  got  up  and  went  to  his  old  barracks  where  he 
thought  it  would  be  quieter,  so  that  he  might  get  some  sleep. 
He  was  found  in  a  confused  state  lying  on  a  bed  spring,  and 
sent  by  a  physician  to  the  base  hospital.     He  was  afraid  some- 


THE    KINGDOM    OF    EVILS  361 

thing  was  going  to  happen  to  him,  and  was  excited  and  very 
talkative. 

In  this  hospital  he  was  normal  in  behavior,  but  very  worried 
because  he  feared  he  would  lose  his  standing  if  it  were  known 
that  he  was  discharged  from  the  army  because  he  was  "crazy." 
It  was  the  opinion  of  the  medical  staff  that  his  mental  disturb- 
ance was  not  of  the  nature  of  a  psychosis,  though  they  were 
not  able  to  determine  exactly  what  type  of  disorder  he  had 
suffered  from.  Four  months  later  Giordani  was  playing  in  a 
summer  hotel,  and  wrote  that  he  was  quite  well. 

Hours  spent  by  Medical  record,  27  pages 

Social  record,  i  page 
Physician,  4^/^  Social  work  : 

Visits,  0 
Psychologist,   I  Interviews  at  hospital,  3 

Telephone  calls,  o 
Social  worker,   ij4  Letters,  2 


Draftsman  who  thought  people  laughed  at  him.  Given  work 
alone,  his  earnings  doubled. 

Case  100,  Henry  Allen  made  a  very  high  mental  test, 
being  especially  good  in  construction  puzzles.  He  had  come 
to  the  hospital  as  a  voluntary  patient  in  a  depressed  frame  of 
mind,  feeling  unable  to  do  his  work.  He  had  been  sleeping 
poorly.  He  was  fifty  years  of  age  and  was  physically  quite 
negative  except  for  tremors  of  the  tongue  and  fingers.  He 
complained  of  headache,  aches  in  the  bones,  shortness  of 
breath,  and  general  weakness,  but  there  was  no  physical  basis 
determined  for  these  particular  complaints.  He  said  that  peo- 
ple laughed  at  him  and  said  things  about  him  in  the  office  where 
he  worked  and  that  they  had  been  doing  this  for  years.  In  fact, 
he  had  really  for  years  been  worrying  about  this  attitude  of  his 
fellow  workers  but  had  kept  on  in  the  ofifice  up  to  a  fortnight 
since. 

We  found  Allen  a  most  instructive  case  from  a  certain  in- 
dustrial, vocational  aspect.  He  despised  the  constructional  de- 
tails in  his  work  and  rather  wanted  to  do  designing.  Of  course 
the  details  in  designing  would,  no  doubt,  have  been  as  elaborate 
as  the  details  of  the  constructive  work;  apparently  it  was  the 


362  THE   KINGDOM    OF   EVILS 

matter  of  an  attitude  adopted  by  Allen  to  the  general  nature 
of  his  work  rather  than  to  his  mechanical  capacity  in  it.  It 
was  as  if  he  wanted  to  be  more  of  a  figure  in  the  whole  office 
by  doing  designing  rather  than  constructive  detail.  As  the 
other  workmen  so  constantly  talked  about  him  (as  he  thought) 
he  did  not  want  to  work  in  a  large  office  with  many  looking  on. 
He  felt  he  had  worked  only  up  to  about  twenty-five  per  cent 
of  his  efficiency  because  he  had  not  been  rightly  placed  in  the 
office. 

The  hospital  diagnosis  remains  at  psychopathic  personality 
but  very  possibly  we  should  regard  this  patient  as  tending 
towards  the  cyclothymic  (manic-depressive)  constitution  where 
he  belongs  in  the  depressive  group.  According  to  his  own 
story  he  has  been  somewhat  blue  all  his  life.  The  self -accusa- 
tory trend  is  a  characteristic  of  such  cyclothymics.  Very  pos- 
sibly his  idea  that  he  was  being  persecuted  by  fellow  workers 
would  transform  itself  upon  analysis  into  a  form  of  self- 
accusation  nor  does  the  story  of  the  whole  case  suggest  any- 
thing paranoid,  that  is,  looking  in  the  direction  of  the  persecu- 
tory delusions  of  a  schizophrenic. 

Allen's  case  came  up  for  particular  consideration  at  a  meet- 
ing of  employment  managers  at  the  Psychopathic  Hospital. 
It  was  at  that  time  suggested  that  he  ought  to  work  for  a  firm 
large  enough  to  employ  a  number  of  designers  so  that  he  might 
be  given  the  work  he  liked,  rather"  than  merely  constructive 
detail.  It  was  also  suggested  that  he  should  work  alone  in  an 
office.  These  suggestions  have,  in  a  measure,  been  met  by  ar- 
rangement with  an  employer  who  has  given  him  greater  and 
greater  responsibility  in  his  work.  Short  notices  and  pressure 
upon  him  for  rapid  work  are  avoided.  He  is  earning  now 
twice  as  much  as  before.  One  of  Allen's  letters  to  the  social 
worker  will  tell  the  story. 

"My  Dear  Miss  Hall: 

"Your  inquiry  with  enclosure  from  my  sister  has  only  just 
reached  me,  owing  to  an  error  made  in  forwarding  at  the  post 
office. 

"My  conscience  has  reproached  me  many  times  of  late  for 
my  apparent  discourtesy  in  neither  reporting  or  calling  at  the 
Psychopathic  and  letting  you  know  what  had  become  of  me. 
Owing  to  the  exigencies  of  Mr.  Anderson's  work,  in  part,  and 
more  perhaps  because  I  knew  you  were  on  your  vacation,  I 


THE    KINGDOM    OF    EVILS  363 

waited  at  first  to  get  myself  adjusted,  and  lately  have  had  so 
much  given  me  to  do  it  has  taken  all  my  time  and  energy  to 
accomplish  what  was  expected  of  me.  I  am  working  very 
smoothly  and  getting  a  good  deal  done,  but  only  by  close  appli- 
cation. I  am  not  just  ready  yet  to  form  an  opinion  as  to  how 
it  will  work  out  for  me.  Expect  to  get  together  with  Mr. 
Anderson  on  his  return  from  the  South  in  a  few  days  and  see 
if  I  cannot  get  things  adjusted  more  satisfactorily. 

"The  conditions  the  work  demands  are  speed,  efifectiveness, 
and  thought.  The  two  latter  I  can  supply  but  not  the  former, 
so  my  problem  with  myself  and  with  him  is  to  reach  a  compro- 
mise which  I  hope  in  fact  must  work  out.  One  cannot  work 
for  Mr.  Anderson  without  being  put  on  their  mettle,  even 
when,  as  is  certainly  true,  he  is  one  of  the  kindest  and  in  inten- 
tion considerate  of  employees,  and  always  interesting. 

"For  reasons  best  known  to  himself  he  has  established  me  in 
my  own  office  or  work  room  at  considerable  present  expense 
to  himself.  His  work  would  be  considered  by  a  designer  or 
landscape  man  as  of  a  very  choice  and  charming  character. 
It  is,  or  should  be,  all  beautiful.  Just  how  I  shall  measure  up 
to  the  opportunity  we  will  have  to  wait  and  see. 

"Personally  I  feel  that  I  have  benefited  by  my  stay  at  the 
Psychopathic  and  the  difficulty  of  concentration  which  I  once 
mentioned  to  you  seems  no  longer  to  exist  in  my  work.  Will 
you  please  remember  me  very  kindly  to  Dr.  Reed,  Dr.  Patter- 
son, Miss  Dean,  and  the  others? 

"In  closing  I  can  only  say  that  I  am  not  sure  yet  for  reasons 
more  readily  said  than  written,  whether  or  not  the  work,  as  it 
is  coming  to  me,  will  prove  the  work  that  I  should  wisely  en- 
deavor to  hold.  I  am  trying  it  out  in  the  most  matter-of-fact 
and  sensible  way  I  can  and  am  reserving  my  final  opinion. 

"When  it  has  developed  a  little  farther,  I  may  want,  if  I  may 
do  so  without  imposing  unduly  on  your  time,  to  talk  over  condi- 
tions as  they  develop.  For  no  matter  how  ideal  the  nature  of 
the  work  may  be  I  am  by  no  means  sure  that  ultimately  to  be 
pinned  down  as  closely  to  a  drawing  board  as  I  have  been  will 
become  impossible — physically  I  am  waiting  to  see. 

"I  trust  that  your  vacation  has  been  very  beneficial  to  you 
and  that  you  have  returned  to  your  profession  refreshed  for 
the  work  which  I  am  sure  is  as  exacting  and  trying  on  the  social 
workers  in  some  ways  as  it  is  helpful  and  beneficial  to  the 
people  you  help. 

"Trusting  you  will  pardon  the  length  of  my  letter  and  my 
delay  in  writing,  I  am  "Very  sincerely, 

"Henry   Allen." 


364  THE    KINGDOM    OF    EVILS 

"p.s.  It  has  occurred  to  me  that  what  I  have  written  of 
my  work  may  suggest  to  you  that  I  am  being  unduly  confined. 
It  is  true  for  the  time  being,  but  I  think  I  shall  remedy  it 
without  difficulty ;  and  add  this  lest  you  should  think  it  wise  to 
write  Mr.  Anderson  on  the  subject,  for  I  know  it  is  part  of 
your  profession  to  look  after  the  patients  when  they  need  it. 
In  this  case  there  is  nothing  but  will  adjust  itself.  And  it  is 
all  incidental  to  getting  started,  so  while  I  have  written  to  you 
frankly  I  shall  be  quite  as  frank  with  Mr.  Anderson  and  can 
instantly  make  it  right,  and  I  do  not  know  how  he  would  take 
a  suggestion  from  the  stafif  while  I  am  certain  he  will  from  me. 
Probably  you  wouldn't  think  of  it  in  any  case.  But  I  have  such 
a  warm  regard  for  the  intelligent  work  you  are  doing  at  the 
.  Psychopathic  I  am  sure  you  would  do  it  unless  you  knew  there 
was  no  need ! 

"If  there  is  any  further  information  I  can  send  you  at  any 
time,  I  shall  be  only  too  happy  to  do  so. 

"H.   A." 

It  is  a  question  whether  it  would  not  have  been  wiser  to  have 
Allen  overcome  his  fear  of  working  in  a  large  office.  Possibly 
if  we  had  regarded  his  condition  as  cyclothymic  or  an  obses- 
sional cme,  it  might  have  been  wiser  to  try  to  break  up  the 
obsession  by  counsel  and  the  initiation  of  new  habits.  Where 
we  are  dealing,  however,  not  with  besetting  ideas  so  much  as 
w^ith  a  habitual  and  self -accusatory  gloom,  it  is  not  likely  that 
"rationalizing,"  or  idea  upsetting,  psychotherapy  would  be 
much  in  point.  Here  again,  as  in  the  case  of  Arthur  Morton, 
the  differential  diagnosis  between  the  depression  of  psycho- 
neurosis  and  the  depression  of  a  constitutional  cyclothymia  be- 
comes a  matter  of  extremest  importance  to  the  victim  of  the 
depression  which  is  aided  by  rationalization  on  the  one  hand, 
and  no  doubt  by  abstention  from  psychotherapy  of  the  argu- 
mentative or  persuasive  sort  on  the  other. 

Hours  spent  by  Medical  record,  18  pages 

Social  record,  38  pages 
Physician,  4^  Social  work  : 

Visits,  2 
Psychologist,   I  Interviews  at  hospital,  20 

Telephone  calls,  10 
Social  worker.  Letters,  19 


BOOK  IV 


What  is  man,  that  Thou  shouldest  magnify  him, 
And  that  Thou  shoiddest  set  Thy  mind  upon  him, 
And  that  Thou  shoiddest  visit  him  every  morning, 
And  try  him  every  moment? 

Job,  Chapter  7,  Verses  17,  18. 


EPICRISIS 

The  descriptive  task  of  this  volume  is  complete.  The  body 
of  the  text  presents  a  set  of  social  cases  chosen  from  psy- 
chiatric material  to  illustrate  the  theory  and  practice  of 
social  work.  The  first  three  books  present  the  practice  of 
social  work  inductively,  to  the  end  that  the  student  may  almost 
unconsciously  gain  an  insight  into  the  underlying  principles  of 
diagnosis  and  treatment  in  social  cases.  To  be  sure  the  reader 
will  find  scattered  amongst  the  case-descriptions  in  all  three 
of  these  books  numerous  theoretical  remarks.  But  in  Book 
IV  these  scattered  remarks  concerning  theory  are  to  be  united 
into  a  body  of  principles.  At  the  outset  of  Book  IV  we  shall 
offer  statements  of  an  exceedingly  general  nature,  designed  to 
align  this  work  with  others  bearing  on  the  various  arts  and 
sciences  that  have  come  to  be  termed  sociological. 

RELATIONS   OF    SOCIAL   WORK   TO    SOCIOLOGY    AND    PSYCHIATRY 

There  is  not  much  in  books  on  sociology,  ancient  or  modern, 
that  touches  even  the  theory  of  social  work.  Works  on  so- 
ciology since  the  establishment  of  the  theory  of  evolution 
have  treated  mainly  the  relation  of  the  family  taken  as  a 
group  to  the  community  also  taken  as  a  group.  That  both 
the  family  group  and  the  community  group  are  sets  of  individ- 
uals, no  sociologist  ever  denies.  Indeed  some  sociologists  pro- 
claim that  the  unit  of  sociology  is  and  must  be  the  human 
individual.  But  we  believe  it  is  fair  to  say  that  modern  soci- 
ology is  in  the  main  a  theory  of  the  relation  of  human  groups 
to  one  another  rather  than  of  the  relation  of  the  individual 
"soul"  to  its  fellow  or  fellows  in  daily  life. 

Certain  it  is  that  the  sociology  books  rarely  present  any  case 
material  after  the  manner  of  the  present  work.  Yet  there  is 
much  to  be  said  for  building  up  a  new  sociology  from  the  bot- 
tom. If  we  are  to  build  thus  from  the  bottom,  we  must  cer- 
tainly begin  with  the  relations  of  man  to  man,  woman  to 
woman,  and  man  to  woman,  whether  those  relations  are  by 

367 


368  .     THE    KINGDOM    OF   EVILS 

blood,  by  marriage,  or  otherwise.  What  has  been  done  by 
jurists  upon  domestic  and  personal  relations  is  not  only  meager 
but  in  part  doubtless  quite  false,  being  founded  on  the  very 
partial  insights  obtainable  by  Bench  and  Bar.  Many  of  the  sit- 
uations that  we  have  described  above  will  suggest  dire  need  of 
logical  analysis  of  personal  relations  with  a  deeper  insight  and 
a  less  general  point  of  view  than  the  juristic  one.  This  new 
point  of  view  and  insight  we  can  only  in  this  work  faintly 
indicate.  We  conceive  that  social  work  will  some  day  pass,  in 
the  form  of  more  or  less  definite  principles,  into  a  great  body 
of  sociological  theory.  The  new  sociology  will  in  our  opinion 
be,  not  merely  a  theory  of  human  "groupism,"  but  a  theory  of 
the  relation  of  individuals  to  each  other.  Though  the  student 
of  social  work  can  today  find  little  or  nothing  to  his  purpose 
in  sociology  books,  he  should  not  despair.  He  is  himself 
recording  facts  that  will  go  to  make  up  new  sociological  text- 
books of  the  future  and  give  the  theory  of  human  group  rela- 
tions its  proper  fundament  in  a  theory  of  human  individual 
relations. 

In  one  sense  this  volume  is  a  collection  of  cases  of  social 
maladjustment.  The  whole  of  life,  according  to  Herbert 
Spencer,  is  an  adjustment — a  continuous  adjustment  of 
inner  to  outer  relations.  Roughly  speaking,  we  look  to  the 
psychologists  for  a  study  of  the  innermost  of  life's  inner  rela- 
tions. Perhaps  it  is  not  astonishing  that  we  should  find  the 
sociologists  beginning  with  the  outermost  of  life's  relations, 
namely  the  group  relations  of  the  family  to  the  community. 
But  the  history  of  the  mental  sciences  in  recent  years  shows 
that  the  psychologists  are  beginning  to  study  man's  inner  rela- 
tions as  they  touch  society  (witness  books  like  McDougall's 
Social  Psychology)  and  that  the  sociologists  are  beginning  to 
write  books  that  endeavor  to  carry  society  back  to  certain 
springs  of  action  in  the  individual  mind.  In  short  we  can  see 
signs  that  the  mental  sciences  are  beginning  to  study  not  merely 
life's  inner  relations  as  such  and  life's  outer  relations  as  such, 
but  also  the  adjustments  of  interrelations  of  the  two.  Now 
the  social  worker  stands  in  the  practical  center  of  these  adjust- 
ments, so  far  as  they  concern  the  relations  of  man  to  man. 
The  contributions  of  the  psychologists  and  of  the  sociologists 
are  still  as  separately  visible  to  the  readers  of  books  on  so-called 
social  psychology  as  the  separate  flows  of  the  Missouri  and 


THE    KINGDOM    OF    EVILS  369 

the  Mississippi  for  a  long  time  after  their  junction.  We  are 
now  inductively  building  up  the  facts  for  a  true  social  psy- 
chology (or  shall  we  say  psycho-sociology f) ,  which  is  to  be 
something  new  in  which  the  contributions  of  psychologists  and 
of  sociologists  will  no  longer  be  separately  recognizable  as  such. 
Adaptation  is  the  key  word  of  much  of  the  psychology, 
sociology,  economics,  and  political  science  of  the  nineteenth 
century.  Adaptation  and  maladaptation  are  the  key  words  of 
our  own  branch  of  practical  or  applied  sociology  called  social 
work.  The  hurnan  mind  is  no  doubt  the  most  exquisite  of  the 
adjustments  of  which  the  nineteenth  century  talked  so  much. 
But  the  supreme  organization  of  man's  mind  has  its  penalty. 
That  penalty  is  the  ease  of  its  maladjustment  and  maladapta- 
tion. Man  builds  up  outer  relations  quite  as  complex  as  his 
own  inner  ones.  There  are  frequent  flaws  both  in  the  psychic 
interior  of  man  and  in  his  environment.  These  flaws,  whether 
in  the  shape  of  initial  lacks,  or  of  acquired  losses,  or  of  mere 
twists  without  lack  or  loss  of  constituent  elements,  can  hardly 
be  made  good  without  extraordinary  effort,  conscious  and  un- 
conscious, on  the  part  of  man.  These  efforts  we  term  efforts 
at  reform,  reconstruction,  rehabilitation,  readjustment,  readap- 
tation. 

The  fitness  of  the  environment  to  life  has  been  affirmed 
with  great  strength  and  skill  by  the  modern  sciences  of  chem- 
istry and  physics  (witness  such  works  as  those  of  L.  J.  Hen- 
derson on  the  Fitness  of  the  Enznromnent  and  the  Order  of 
Nature).  Yet  the  fitness  of  man  in  his  environment,  or  the 
fitness  of  the  environment  to  man,  is  a  very  general  and  loose 
adaptation  rather  than  a  special  and  precise  one.  Whether  it 
is  the  generality  of  the  laws  of  environmental  fitness  or  whether 
there  is  some  other  reason,  we  have  no  point  to  bring  in  this 
work ;  but  it  is  obvious  enough  that  human  maladjustments  do 
occur  precisely  on  the  plane  in  which  life's  inner  relations  meet 
the  outer  ones.  Man  perhaps  shows  the  defect  of  his  virtue. 
He  has  high  sensibility  and  a  delicate  responsiveness  to  his 
environment.  He  finds  most  ingenious  ways  of  shunning  ob- 
stacles. But  he  finds  equally  ingenious  ways  of  contriving 
new  obstacles,  along  with  the  devising  of  new  ideas,  practical 
and  theoretical.  To  use  a  homely  figure,  man  is  often  in  the 
plight  of  an  adventurous  cat,  which  has  climbed  a  tall  tree 
with   admirable  audacity,   but   finds   herself   quite   unable   or 


370  THE    KINGDOM    OF   EVILS 

unwilling  to  climb  down.  The  order  of  events  is  (a)  the 
existence  of  a  perfectly  good  general  adjustment  of  life's  rela- 
tions, (b)  the  development  of  specific  maladjustments  between 
those  relations,  and  (c)  the  social  necessity  of  readjustment 
amongst  the  relations.  The  social  worker  cannot  be  respon- 
sible, as  social  worker,  for  the  integrity  or  the  interior  perfec- 
tion of  the  minds  of  the  human  beings  dealt  with.  Again  the 
social  worker  cannot  be  responsible  for  the  status  of  all  the 
outer  relations  which  are  indispensable  to  life. 

The  duty  of  the  social  worker  lies  in  the  plane  of  adjust- 
ment and  of  readjustment  between  the  human  mind  and 
society.  Modern  social  work  undertakes  consciously  to  effect 
readjustment,  so  far  as  possible,  in  all  concrete  human  cases 
in  which  the  vital  relations,  inner  and  outer,  have  become  mu- 
tually disorganized.  Society  has  come  to  regard  itself  as  more 
and  more  responsible  for  the  cure  and  the  prevention  of  all 
human  maladjustments.  The  man  who  takes  a  serious  view 
of  human  life  and  human  society  on  the  one  hand  may  seek 
to  promote  man's  "welfare"  or  on  the  other  hand  he  may  pre- 
fer to  think  in  terms  of  man's  increased  "efficiency."  In  either 
event  the  serious  student  of  social  adjustments  is  looking 
towards  concrete  betterment.  In  a  practical  age,  and  with  the 
inevitable  memories  of  the  Great  War,  the  student  of  sociology 
grows  weary  of  abstractions,  generalizations,  and  universal 
formulae,  such  as  dogged  the  world's  footsteps  before  and  up 
to  the  year  1914.  Modern  social  work  finds  the  prevailing 
after-war  spirit  identical  with  its  own  familiar  spirit  of  recon- 
struction. For  decades,  doubtless,  the  world  will  be  in  a  frame 
of  mind  to  repair  and  restore  rather  than  to  build  uncertain 
novelties  upon  shifting  foundations.  Social  work  has  in  fine 
come  into  a  perfectly  congenial  atmosphere.  Social  work  can 
be  at  the  same  time  as  charitable  as  it  likes  and  as  efficient  as 
it  likes. 

Just  as  man  is  more  complex  and  less  stable  than  other 
forms  of  life,  so  inside  man  himself  is  man's  mind  more  com- 
plex and  less  stable  than  all  else  he  possesses.  Man's  mind 
is  at  the  center  and  crossing  of  all  those  inner  relations  which 
Spencer  defined  as  requiring  adjustment  to  the  outer  world. 
If  modern  social  work  demands  readjustment  of  man  to  his 
environment,  not  to  say  of  the  environment  to  man,  then  it  is 
clear  that  the  specialist  in  social  adjustment  must  find  his  chief 


THE    KINGDOM    OF    EVILS  37I 

aid  and  mainstay,  but  also  the  greatest  bugbear  and  stumbling- 
block,  in  this  selfsame  highly  sensitive,  highly  unstable  mind. 
Inside  the  developing  specialty  of  social  work  there  is  now 
unfolding  with  great  speed  and  surprising  precision  a  new 
type  of  social  work  called  psychiatric. 

Psychopathology  and  psychiatry  are  respectively  the 
science  of  the  mind  diseased  and  the  art  of  mental  healing. 
Psychiatric  facts  and  observations  are  what  constitute  that 
practical  specialty  of  medicine  known  as  psychiatry.  Psychia- 
try is  a  practical  branch  of  medicine.  Sometimes  its  theoretical 
side  is  given  the  name  psychopathology.  Psychopathologists 
are  theorists  that  describe  and  explain  what  we  scientifically 
know  or  think  we  know  concerning  mental  diseases.  For 
example,  William  James,  besides  being  a  psychologist  (that  is 
a  theorist  dealing  with  the  normal  and  general  aspects  of  the 
mind)  was  a  psychopathologist  (that  is  a  theorist  dealing  with 
morbid  aspects  of  mind)  ;  and  the  interested  reader  will  still 
find  in  James's  larger  Psychology,  published  in  1890,  a  ma- 
jority of  the  important  facts  concerning  the  general  theory  of 
mind  and  concerning  its  morbid  aspects.  Indeed,  the  general 
reader  is  perhaps  safer  in  the  reading  of  that  older  work  than 
in  the  somewhat  precarious  plunges  he  might  readily  make  in 
the  current  magazine  literature.  But,  although  James  was  a 
psychologist  of  the  first  rank  and  a  psychopathologist  amongst 
the  most  competent,  he  would  not  have  claimed  to  be  a  psychia- 
trist. To  be  sure  James  bore  the  M.D.  degree;  but  he  was 
not  a  practitioner  of  medicine  and  therefore  not  in  the  fullest 
sense  a  psychiatrist.  The  interested  layman  must  never  con- 
found theory  with  practice,  chemistry  with  dietetics,  physics 
with  bridge-building,  psychopathology  with  psychiatry,  the 
theory  of  mental  disorder  with  the  practice  of  the  cure  and 
prevention  of  mental  disease. 

The  layman  is  drawn  by  a  mysterious  yet  perfectly  legiti- 
mate attraction  into  the  field  of  what  used  to  be  called  in- 
sanity, but  which  we  now  like  to  spread  out  into  the  field  of 
mental  diseases  and  defects.  Time  was  when  insanity  was 
somehow  in  the  same  breath  attractive  and  repellent.  On  the 
whole  the  mind  diseased  was  a  forbidding  topic.  Nowadays 
the  situation  is  altered.  To  be  sure,  there  are  in  various  recep- 
tacles contrived  by  the  philanthropic  and  self -insuring  state 
governments   a  certain   number  of  legally  insane  persons,   a 


372  THE    KINGDOM    OF    EVILS 

great  many  more  in  the  urbanized  states  of  Massachusetts  and 
New  York  than  in  rural  and  unorganized  states.  Of  course 
what  the  civihzed  state  is  here  doing  for  the  chronic  insane  is 
in  itself  a  kind  of  social  work  which  makes  for  betterment  in 
the  state.  But  the  benefits  for  the  state  at  large  are  rather 
negative  than  positive,  and  only  in  states  of  an  advanced  civ- 
ilization is  there  much  coordinated  effort,  by  special  treatment, 
by  medical  and  social  teaching,  and  by  well-conceived  re- 
searches, to  the  end  of  directly  helping  the  victims  inside  asy- 
lums and  their  families  at  home.  Which  means  to  say  that 
the  highest  type  of  social  work,  both  general  and  psychiatric, 
is  seldom  found  upon  the  planet.  Still,  in  the  most  urban  por- 
tions both  of  our  Atlantic  seaboard  and  in  parts  of  the  interior, 
where  the  need  is  most  urgent,  successful  social  work,  both 
general  and  psychiatric,  is  being  carried  on.  The  phrase  "ex- 
perimental stage"  can  no  longer  be  properly  hurled  at  this  work. 
The  blue-prints  of  it  have,  so  to  speak,  been  manifolded.  Com- 
mittees like  the  National  Committee  for  Mental  Hygiene  are 
forwarding  the  work  throughout  this  country.  But  for  years 
to  come  the  work  of  such  committees  in  many  states  and  com- 
munities must  be  limited  perforce  to  that  perfectly  crystallized 
form  of  social  work  frequently  known  as  "state  care  of  the 
insane." 

In  the  first  part  of  this  work  we  have  called  attention  to 
the  distinction  between  public  endeavor  and  social  endeavor, 
contrasting  the  public  and  social  spheres  of  influence  with 
the  more  personal  and  individual  sphere.  Practically  we  no 
longer  term  social  work  that  special  portion  of  the  community's 
task  which  has  been  taken  over  by  organized  government  and 
reduced  more  or  less  to  thumb  rules,  which  are  perfectly  good 
rules  unless  interfered  with  by  the  exigencies  of  the  public 
treasury,  real  or  imaginary.  There  is  a  good  deal  in  the  public 
(that  is  organized  governmental)  service  which  the  social 
worker,  operating  from  voluntary  agencies,  cannot  touch  or 
modify.  The  social  worker  then  has  to  operate,  as  the  military 
men  say,  "through  channels."  Nevertheless,  the  voluntary 
agency  is  often  able  to  flick  the  wheel  of  officialdom.  The  fit 
of  government  and  law  is,  we  are  almost  inclined  to  thank 
Heaven,  not  a  close  fit.  The  legal  order  and  the  administrative 
order  are  general  rather  than  individual  in  their  application,. 


THE    KINGDOM    OF    EVILS  373 

There  is  a  wavy  line  separating  the  pubhc  from  the  private 
(where  we  mean  by  "private"  either  social  or  personal  consid- 
erations, not  yet  reduced  to  rigid  rules  and  regulations). 
There  is  also  a  wavy  line  between  social  considerations  on  the 
one  hand  and  personal  ones  on  the  other. 

The  successes  of  public  health  and  preventive  medicine 
it  is  no  part  of  the  present  work  to  restate.  Public  service  is 
one  of  the  most  successful  things,  so  far  as  it  goes,  that  man 
has  accomplished.  The  theory  of  sanitation  passed  smoothly 
and  efficiently  from  a  set  of  considerations  bearing  on  such 
matters  as  sewage  and  other  sanitary  concerns  to  another  far 
more  delicate  set  of  considerations  bearing  on  infection  and 
bacteriology.  The  public  health  movement  is  now  passing  into 
a  phase  in  which  personal  hygiene  is  coming  into  sharp  focus. 
The  mental  hygiene  movement  is  about  to  fuse  with  the  rest 
of  the  doctrines  of  public  health.  An  important  part  of  mental 
hygiene  is  a  public  affair.  In  the  same  state  governments  that 
were  developing  departments  of  health,  another  movement  was 
quietly  going  forward  for  the  so-called  "state  care  of  the 
insane."  This  program  is  well-nigh  complete,  so  far  as  the 
legally  insane  are  concerned.  The  models  for  state  care  have 
been  laid  down.  In  several  parts  of  the  world  public  service 
has  done  practically  all  that  our  knowledge  now  allows  for 
the  group  of  unfortunates  known  as  the  chronic  insane. 

But  the  chronic  insane  form  a  comparatively  small  group 
of  unfortunates.  Psychiatry,  as  almiost  any  case  in  this  book 
will  prove,  is  luckily  no  longer  limited  to  the  classification,  care, 
and  treatment  of  the  legally  insane.  For  every  insane  person 
now  confined  in  a  state  receptacle,  it  may  be  suspected  that  there 
is  another  almost  or  quite  equally  insane  person  outside  brick 
walls  who  might  very  appropriately  be  interned  at  once  for  his 
own  sake  and  for  the  state's  sake.  Laws  for  the  temporary 
reception  and  care  of  such  suspects  have  been  placed  on  the 
statute  books  of  a  few  of  the  most  civilized  states.  In  some 
of  these  states  special  psychopathic  hospitals  have  been  built 
and  equipped  for  their  care  and  specialized  treatment,  study 
and  investigation.  The  data  of  this  book  intend  to  bring  to  the 
layman  and  to  the  social  worker  special  information  concern- 
ing mild,  incipient,  and  dubious  cases  of  mental  disease,  which 
we  shall  come  to  know  either  as  mild  instances  of  various  well- 


3/4  THE    KINGDOM    OF    EVILS 

known  mental  diseases  or  else  merely  as  psychopaths  (i.e.,  not 
subject  to  diseases  of  a  well-known  and  definite  character — 
as  it  were  unspecified  cases). 

But  the  aim  of  modern  mental  hygiene  is  much  more  ambi- 
tious. How  can  the  tasks  of  modern  mental  hygiene  be  de- 
fined? It  is  plain  that,  if  our  analysis  of  "spheres  of  influence" 
in  Book  I  is  correct,  mental  hygiene  might  well  deal  with  (a) 
the  establishment,  maintenance,  and  improvement  of  various 
public,  legal,  and  administrative  institutions  and  relations,  (b) 
the  encouragement  and  improvement  of  various  voluntary  and 
private  agencies  for  the  betterment  of  social  relations  and  the 
molding  of  society's  opinion  on  these  matters,  and  (c)  the  es- 
tablishment of  new  facts  and  devices  for  improving  man's  in- 
dividual relations,  particularly  the  very  interior  relations  of  the 
man  to  himself. 

The  mental  hygienist  of  the  present  day,  whether  he  be  a 
psychological  theorist,  a  specialist  in  mental  tests,  a  psycho- 
pathologist  with  theoretical  interest  paramount,  a  practical  psy- 
chiatrist, or  an  educationalist  specially  concerned  with  high  or 
exceptional  talents  or  with  the  "ungraded,"  wants  to  spread  a 
gospel  about  mind  much  wider  than  the  crystallized  doctrines 
of  medico-legal  insanity,  the  newer  knowledge  about  the  "tem- 
porary care"  (psychopathic  hospital)  group  and  the  out-patient 
group  of  mental  diseases  and  effects  of  a  more  or  less  mild 
nature.  The  ambition  of  modern  mental  hygiene  is  to  spread 
its  point  of  view  over  the  entire  field  of  the  mental  sciences 
and  arts,  wherein  sociology  and  economics  look  especially  ac- 
cessible. Not  only  the  insane,  not  only  the  psychopaths,  but 
also  the  eccentrics  and  the  very  slightly  subnormal  are  topics 
for  modern  mental  hygiene.  Nor,  as  above  hinted,  would 
mental  hygiene  object  to  considering  the  supernormal  person 
and  the  person  with  specialized  capacities  as  within  the  range 
of  its  point  of  view.  We  may  mention  again  the  work  of 
William  James,  this  time  pointing  out  how  in  his  Varieties  of 
Religious  Experience,  published  in  1903,  he  utilized  his  vast 
psychological  and  psychopathological  equipment  in  the  study 
of  what  he  sometimes  termed  the  religious  "geniuses."  It  is 
worth  while  insisting  that  the  psychiatric  approach  does  not 
mean  calling  everybody  crazy  or  even  a  little  bit  crazy !  James 
himself  went  to  extraordinary  lengths  in  his  chapter  on  "Re- 
ligion and  Neurology"  to  refute  this  idea.     James's  acid  test 


THE    KINGDOM    OF    EVILS  375 

of  psychopathology  did  not  destroy  the  golden  geniuses  of 
religion.  When,  therefore,  we  say  we  want  to  apply  the  psy- 
chiatric insight  to  practically  the  entire  human  world,  we  are 
not  at  all  asserting  or  suspecting  that  the  majority  of  human 
beings  are  in  any  sense  psychopathic.  We  believe  that  more  of 
the  psychiatric  point  of  view  will  be  of  great  service  to  the 
world,  as  well  in  domestic  as  in  political  life.  Just  as  James 
gave  new  viewpoints  concerning  the  religious  ecstasy,  and  just 
as  Hippocrates  and  Galen  before  him  were  physicians  who 
made  the  most  extraordinary  contribution  to  our  knowledge  of 
temperament,  so  we  hope  by  the  spread  of  the  mental-hygienic 
point  of  view  and  the  point  of  view  of  psychiatric  social  work 
to  aid  the  common  man  and  woman  to  deeper,  practical  insights 
into  everyday  questions. 

METHOD  OF  APPROACH 

We  shall  now  try  to  describe  in  a  few  sentences  and  in  the 
most  general  way  the  somewhat  novel  method  of  approach 
adopted  in  this  book. 

There  has  heretofore  been  no  special  treatise  upon  psychiat- 
ric social  work.  There  is  in  fact  no  comprehensive  treatise 
upon  social  work  in  general.  Accordingly  this  book  has  per- 
force to  include  much  that  may  seem  entirely  non-psychiatric. 
We  do  not  seek  to  describe  comprehensively  the  technique  of 
social  diagnosis  or  the  technique  of  social  treatment.  The  gen- 
eral features  of  the  technique  of  social  diagnosis  have  been 
ably  catalogued  by  Miss  Mary  E.  Richmond  in  her  work  on 
Social  Diagnosis.  Comprehensive  studies  upon  Social  Treat- 
ment are  rumored  to  be  in  preparation,  and  the  experiences  of 
decades,  from  the  first  philanthropic  endeavors  up  to  the  more 
scientific  procedures  of  present-day  social  treatment,  may  then 
become  available  for  the  growing  group  of  general  social 
workers.  It  is  not  our  design  to  anticipate  future  formulation 
of  the  methods  of  social  treatment  or  to  repeat  the  systematic 
chapters  of  Richmond,  so  far  as  they  deal  with  mental  hygiene 
and  psychiatry.  We  have  carefully  reviewed  Richmond's 
work  and  found  to  our  surprise  that  fully  half  of  the  social 
cases  presented  by  her  are  cases  with  a  strong  mental  hygienic 
or  psychiatric  flavor.  What  this  signifies  can  be  discerned  if 
we  remember  that  Richmond's  selection  of  cases  was  a  purely 


376  THE    KINGDOM    OF    EVILS 

random  selection,  made  for  the  purpose  of  illustrating  differ- 
ent forms  of  technique  of  social  diagnosis.  The  collection  was 
in  no  sense  designed  to  display  the  importance  of  psychiatry 
in  social  work.  Reading  between  the  lines  we  can  reasonably 
conclude  that  a  much  higher  proportion  of  the  Richmond  case 
collection  would  turn  out  upon  closer  study  to  be  cases  involv- 
ing mental  hygiene  in  its  broadest  sense — cases,  that  is  to  say, 
that  illustrate  the  importance  of  considering  mild  character 
defects  and  perversions,  mild  feut  important  temperamental 
distinctions,  and  the  like.  Rising  from  this  sort  of  analysis 
(and  any  case  collection  of  social  work,  so  far  seen  by  us,  will 
point  the  same  moral),  we  are  tempted  to  inquire  whether  after 
all  psychiatric  social  work  is  not  merely  social  work  in  general 
with  special  emphasis  upon  its  mental  hygienic  features. 

We  conclude  that  the  present  case  collection  is  perhaps  com- 
prehensive enough  to  amount  to  a  case  collection  demonstrating 
in  the  rough  the  main  principles  of  all  medical  social  work. 
We  bear  in  mind  that  the  great  medical  inspirer  of  the  develop- 
ment of  medical  social  work,  Dr.  Richard  C.  Cabot,  has  for 
years  insisted  that  the  supreme  values  of  medical  social  work 
lodge  in  the  diagnosis  of  human  character  and  the  care  and 
treatment  of  social  patients  in  the  light  of  our  knowledge  of 
their  character.  A  chief  aim  of  medical  social  work  must 
always  have  been  recognized,  more  or  less  vaguely,  as  a  sort 
of  character-building,  a  labor  with  "sick  souls"  as  well  as  with 
sick  bodies,  a  labor  inevitably  interrupted  by  all  sorts  of  tem- 
peramental handicaps.  Even  where  no  such  handicaps  stood 
out  in  silhouette  form  upon  the  history  of  the  patient,  still  even 
the  more  positive  forms  of  character-building  would  need  to 
take  account  of  fundamental,  temperamental,  and  character 
traits.  This  insistence  by  Dr.  Cabot  upon  the  centrality  of 
character-building  in  social  work  took  the  right  line.  But  in 
those  days  the  modern  psychiatric  point  of  view  had  not  ar- 
rived to  deal  with  the  subtle  differences  amongst  men  as  to  their 
temperamental  deviations  and  slight  eccentricities  of  character. 
The  tendency  of  eighteenth-century  individualism  had  been  to 
the  thought  of  general  ethical  principles  common  to  all  men. 
When  the  eighteenth-century  individualism  died  away  to  be 
replaced  by  the  statistical  average  man  of  Ouetelet,  and  when 
Quetelet's  Physique  Sociale  was  supplanted  or  made  over  by 
the  evolutionary  ideas  of  man  as  a  species,  there  was  outstand- 


THE    KINGDOM    OF    EVILS  377 

Ing  a  certain  overgenerality  of  view,  a  certain  opinion  as  to 
desirable  conformities  of  human  beings,  old  and  young,  male 
and  female,  married  and  unmarried,  white  and  black,  to  some 
norm  or  model. 

Nowadays  we  are  beginning  to  look  more  at  differences  than 
at  resemblances  of  human  beings.  Individualization  is  the  war 
cry.  But  the  warp  and  woof  of  the  argument  for  individual- 
ization depends  on  actual  case  material.  This  case  material 
can,  we  think,  be  supplied  nowhere  so  well  as  in  the  wards  and 
out-patient  departments  of  psychopathic  hospitals.  To  the  end 
of  making  character  ultimately  better,  we  now  proximately  look 
at  the  mild  psychopaths,  eccentrics,  and  "deviates"  of  psychi- 
atric clinics.  We  are  often  eloquently  reminded  to  become 
"masters  of  our  fate"  by  the  utilization  of  our  very  handicaps 
themselves.  Grail-hunters,  according  to  available  legends,  had 
sundry  dragons  to  slay  by  the  way.  The  strength  of  Sir 
Galahad  was  as  the  strength  of  ten,  not  merely  because  his 
heart  was  pure,  but  because  of  his  righteous  exercise  of  soul 
and  body  in  the  leaping  of  obstacles  and  the  destruction  of 
evils.  In  point  of  fact,  social  work  did  not  lose  in  moral  fer- 
vor by  taking  on  the  more  scientific  form  of  seeking  social 
justice  rather  than  a  more  or  less  refined  alms-giving.  But 
whether  with  the  philanthropist  you  are  giving  gifts,  or 
whether  with  the  social  worker  you  are  paying  society's  debts, 
— in  either  event  you  are  a  dealer  in  morals.  Even  the  bare 
aim  of  efficiency,  which  causes  our  legislatures  year  by  year 
to  appropriate  more  and  more  money  from  the  tax  levy,  has  a 
moral  motive.  The  watchdogs  of  the  state  treasury,  with 
whom  we  are  so  familiar,  have  their  ears  to  the  ground  of 
morality,  of  social  justice,  and  of  such  altruism  as  the  com- 
munity may  afford.  Yet  withal,  it  must  be  insisted  that  the 
ideas  of  character-building,  of  masterhood  of  fate,  of  the 
utilization  of  one's  handicaps,  of  old-time  philanthropy,  and 
of  modern  social  justice  are  moral  ideas  derived  from  the  gen- 
eral stock  of  such  ideas  to  be  found  in  everyone.  Up  to  recent 
years  the  leaders  in.  social  work,  like  their  predecessors  who 
called  themselves  philanthropists,  took  their  ideas  of  morals 
and  of  moral  development  from  the  general  stock  rather 
than  from  any  special  studies  of  the  moral  status  and  out- 
look of  their  patients,  taken  as  "persons,"  "individuals," 
or  separate  and  distinct  "souls." 


378  THE    KINGDOM    OF    EVILS 

We  are  entitled  to  claim  for  psycniatric  social  work  that  it 
employs  not  only  the  general  stock  of  human  ideas  about  char- 
acter, but  seeks  with  some  success  to  employ  the  new  point  of 
view  of  mental  hygiene.  Possibly  that  point  of  view  can  best 
be  intimated  in  a  single  word  by  the  term  individualization. 
It  was  the  reproach  of  older  medicine,  as  it  was  of  the  educa- 
tional, legal,  and  economic  orders  of  our  own  day,  that  the 
human  unit  was  not  treated  as  a  whole. 

The  late  Professor  James  Jackson  Putnam  was  one  of  the 
earliest  physicians  to  point  out  the  necessity  of  treating  the 
whole  man  rather  than  parts  of  man,  such  as  heart,  liver,  or 
kidneys  taken  as  separately  subject  to  disorder.  Man  seemed  to 
the  analytical  pathologist  of  the  last  century  a  heap  of  viscera, 
in  which  systems  such  as  digestive,  muscular,  nervous,  respira- 
tory, and  excretory  were  to  be  found.  Especially  in  the  last 
decade  of  the  nineteenth  century,  the  "skin  and  its  contents" 
(as  the  slang  medical  phrase  runs)  began  to  be  tied  together 
once  more  through  the  central  nervous  system,  composed,  as 
was  discovered,  of  countless  enormously  long  interconnecting 
strands,  the  so-called  "neurones."  Then  followed  in  the  first 
decade  of  the  twentieth  century  another  process  of  tying  organs 
together.  These  new  ties  were  chemical  ties ;  that  is,  the  so- 
called  ''chemical  messengers"  or  "hormones,"  which  flowed 
through  blood  and  tissues  from  the  glands  which  made  them  to 
the  organs  they  were  designed  to  stimulate  and  control.  Thus, 
by  the  second  decade  of  the  twentieth  century,  even  the  analyt- 
ical pathologists  were  ready  to  see  in  disease  and  health  com- 
binations where  they  formerly  had  seen  separations,  syntheses 
where  they  had  formerly  seen  sundering,  and  all  sorts  of  remote 
effects  which  had  formerly  lain  quite  unsuspected. 

It  was  as  if  a  traveler  had  suddenly  by  the  break  of  day 
become  aware  of  great  numbers  of  telegraph  lines,  great  quan- 
tities of  railway  trackage,  in  a  landscape  which  had  in  semi- 
darkness  seemed  to  him  quite  barren  and  wild,  and  had  become 
aware  of  a  vast  transportation  system  of  highly  artificial  prod- 
ucts capable  of  entirely  altering  the  scene.  The  men  of  science 
had  in  short  by  their  own  endeavors  come  to  see  new  unities  of 
body  and  mind  and  were  once  more  able  to  work  conscien- 
tiously with  their  colleagues  in  social  tasks.  Analytical  men 
of  science  are  thus  now  able  to  work  again  with  the  rest  of  the 
world  on  the  platform  of  individualization.     What  may  be 


THE    KINGDOM    OF    EVILS  379 

called  the  neurone  set-up  of  man,  that  is,  his  nervous  frame- 
work in  the  finest  sense,  is  clearly  a  very  individual  affair,  and 
the  hormone  set-up,  that  is,  the  special  and  intimate  construc- 
tion of  man  in  certain  vital  chemical  ways,  must  needs  be  also 
a  very  individual  matter.  The  individualization  of  man,  as 
we  now  look  at  him  in  the  second  decade  of  the  twentieth  cen- 
tury, is  individualization  to  the  second  power,  or  to  the  cube, 
of  what  it  could  possibly  seem  in  the  third  decade  preceding 
ours,  the  decade  in  which  so  many  extraordinary  discoveries 
in  bacteriology  were  made.  If  it  were  worth  while  to  drag 
the  argument  out 'at  greater  length,  we  could  point  out  the 
obvious  increase  in  individualization  in  the  processes  of  educa- 
tion and  even  somewhat  in  those  of  law  and  economics.  That 
ihe  time  is  ripe  for  individualization  of  morals  can  hardly  be 
doubted.  That  the  technique  by  which  the  world  shall  achieve 
this  individualization  of  morals  is  mental  hygienic  technique, 
we  that  write  this  book  are  persuaded.  The  resulting  distinc- 
tions are  not  medical  distinctions,  but  purely  and  simply  moral 
ones.  In  the  field  of  education  it  is  a  matter  of  familiar  his- 
tory that  Madame  Montessori  derived  her  special  ideas  for  the 
education  of  normal  persons  from  the  study  of  the  methods 
used  for  the  feeble-minded.  So  it  is  with  the  new  insight  into 
morality  which  the  study  of  the  mild  mental  disorders  is  begin- 
ning to  afford.  The  resulting  ethics  will  be  ethics  for  the 
normal  individual.  The  dynamite  of  disease  may  serve  to 
split  out  building  stones.  The  acid  tests  of  medical  study  may 
display  the  true  moral  structure  of  normal  human  beings. 
Psychiatric  social  work  can  establish  and  is  now  estab- 
lishing new  principles  for  social  work  in  general. 

The  time  may  come  when  medicine  can  be  forgotten  and 
hygiene  alone  maintained.  Then  would  be  the  golden  age  of 
keeping  well  rather  than  of  getting  well.  Likewise  psychiatric 
social  work  may  (theoretically)  disappear  and  leave  the  every- 
day problems  of  financial  relief,  of  legal  aid,  of  standardized 
moral  training  and  of  perfectly  systematic  education.  But, 
even  if  such  a  golden  age  without  disease  is  ever  to  develop, 
the  chances  are  good  that  the  study  of  medicine  in  its  broadest 
sense  would  be  an  indispensable  factor  in  the  gilding  process. 
Individualization  is  very  properly  the  war  cry  of  today.  Path- 
ological method  will  have  much  to  do-  in  establishing  the  prin- 
ciples of  that  individualization  upon  a  sound  basis.    That  por- 


380  THE    KINGDOM    OF    EVILS 

.  tion  of  pathological  method  which  deals  with  the  diseases  and 
defects  of  the  mind,  especially  the  mildest  psychopathies  and 
the  faintest  eccentricities,  will  carry  the  banner  of  individu- 
alization to  the  farthest  point  now  visible ;  namely,  the  con- 
fines of  the  mind  of  man.  We  have  already  begun  to  study 
with  delight  and  profit  the  nature  of  geniuses  and  of  excep- 
tional persons  with  special  abilities.  The  varieties  of  moral 
and  religious  experience  are  being  levied  upon  in  the  literature. 

Even  the  legal  order,  which  has  been  so  terribly  general 
in  its  plan  for  securing  the  interests  of  man,  has  begun  to  raise 
the  cry  of  individualization ;  witness  not  only  various  theoreti- 
cal assertions  of  this  trend,  but  witness  the  jurists  themselves 
and  also  the  pleasing  vogue  of  a  book  like  that  of  Dr.  William 
Healy  upon  the  Individual  Delinquent — a  book  founded  upon 
case  descriptions. 

Lastly,  even  in  the  field  of  economics,  a  book  like  that  of 
Taussig  on  Inventors  and  Money  Makers  serves  to  show  how 
far  the  idea  of  individualization  may  penetrate  a  field  devoted 
for  decades,  or  practically  since  its  initial  survey,  to  the  "aver- 
age man."  Social  work,  as  plainly  shown  in  the  case  descrip- 
tions of  this  book,  touches  all  these  fields  of  education,  morals, 
law,  and  economics,  and  must  naturally  share  the  effects  of 
that  increase  in  individualization  which  all  of  these  great  de- 
partments of  knowledge  and  practice  are  showing. 

If  we  concentrate  attention  upon  the  medical  division  of 
the  field  of  social  work  we  cannot  fail  to  see  that  the  individu- 
alizing trend  must  be  greatly  strengthened  by  modern  develop- 
ments in  medicine,  upon  which  the  analyses  of  medical  social 
workers  must  depend.  If  we  further  concentrate  our  attention 
upon  the  psychiatric  division  of  the  field  of  social  work,  we 
cannot  escape  the  conclusion  that  here  at  last  we  find  the  very 
pitch  and  apex  of  individualization.  Landscapes  and  habitats 
extraordinarily  differ.  Races  and  people  differ  still  more 
extraordinarily.  Human  bodies  show  differences  obvious  to 
the  casual  eye,  and  their  contents  such  as  livers,  kidneys,  and 
other  glands,  must  show  even  greater  differences  than  the 
environments  of  their  owners.  When  we  take  into  account 
the  interconnecting  filaments  of  the  nervous  system  and  the 
special  qualities  of  the  various  chemical  messengers  uniting 
the  different  parts  in  the  body  with  one  another,  we  perceive 
that  the  resulting  unities  are  capable  of  still  greater  differentia- 


THE    KINGDOM    OF    EVILS  381 

tion.  Leibnitz  pointed  out  that  no  two  grass  blades  were  alike. 
He  called  his  discovery  by  the  extraordinarily  obscure  name  of 
the  law  of  the  identity  of  indiscernibles.  Well!  if  two  grass 
blades  must  perforce  be  different,  two  brains  interpenetrated 
by  the  highly  specialized  bloods  and  juices  must  be  capable  of 
still  greater  differences  than  mere  grass  blades  could  display. 
From  this  line  of  argument  our  main  claim  will  stand  out; 
namely,  that  progress  in  the  psychiatric  division  of  social 
work  will  inevitably  bring  progress  in  medical  social  work 
las  a  whole.  This  progress  in  medical  social  work  as  a 
whole  must  react  upon  the  more  general  non-medical 
parts  of  social  work. 

What  are  the  relations  between  psychiatric  social  work  and 
other  fields  of  social  case  work?  Logically,  all  portions  of 
the  field  of  social  case  work  are  intimately  connected.  Prac- 
tically, there  are  at  least  three  divisions  of  social  case  work,  if  by 
"practical"  we  mean  divisions  defined  by  the  existence  of  a 
corps  of  special  workers  limited  by  training,  experience,  and 
interest  to  each  special  division.  On  this  practical  ground  we 
may  thus  distinguish  (a)  a  field  of  general  social  case  work, 
(&)  a  field  of  medical  social  case  work,  and  (c)  a  field  of  psy- 
chiatric social  work.  We  here  limit  consideration  to  social 
case  work  as  distinguished  from  the  broader  fields  of  com- 
munity work.  We  speak  merely  of  that  total  field  of  social 
work  that  deals  in  one  way  or  other  with  the  individual,  either 
in  his  public  or  social  or  personal  relations. 

The  point  of  view  of  (a)  the  general  social  case  worker 
derives  historically  from  the  older  philanthropic  point  of  view 
and  is  still  largely  founded  upon  the  necessity  and  desirability 
of  the  so-called  "poor  relief"  and  the  economic  establishment  or 
reestablishment  of  the  family.  (We  must  insist  that  every 
social  case  worker,  whether  general,  medical,  or  psychiatric, 
has  the  family  point  of  view  ingrained  in  her  training  and  im- 
bedded in  her  practice;  the  point  in  the  text  refers  to  the  pre- 
dominance of  the  economic  point  of  view  in  general  social 
work,  pivoting,  as  it  so  often  must,  upon  the  total  wage  intake 
of  the  family  and  its  proper  distribution  or  supplementing.) 

The  point  of  view  of  (&)  the  medical  social  worker  derives, 
not  so  much  from  the  older  philanthropic  point  of  view  as  from 
modern  developments  in  medicine.  The  medical  social  worker 
has  her  economic  interests  indispensably,  for  she  also  pivots 


382  THE    KINGDOM    OF    EVILS 

her  work  upon  the  family.  But  essentially  the  medical  social 
worker  has  in  mind  the  restoration  of  the  health  of  the  family 
and  of  its  individual  components.  Some  of  the  pioneers  in 
medical  social  work  have  been  general  social  workers  who  had 
become  convinced  that  medicine  must  be  their  particular  target. 
But  other  leading  medical  social  workers,  even  at  the  outset  of 
its  development  (see  Ida  M.  Cannon,  Social  Work  in  Hos~ 
pitals),  were  persons  theretofore  quite  untrained  in  the  eco- 
nomic aspects  of  social  work,  who  became  medical  social 
workers  de  novo.  There  was,  to  be  sure,  a  fortunate  union 
and  mutual  adaptation  of  economic  and  social  interests  from 
the  beginning  of  the  development  of  medical  social  work ;  and 
there  are  signs  of  an  equally  happy  reaction  running  both  ways 
between  general  and  medical  social  work. 

The  point  of  view  of  (c)  the  psychiatric  social  worker  de- 
rives from  the  modern  developments  in  mental  hygiene.  Else- 
where in  this  book  we  have  sufficiently  insisted  that  psychiatry 
(that  is,  the  art  of  mental  healing)  is  in  one  very  definite  sense 
a  branch  of  the  practice  of  medicine  but  we  have  pointed  out 
with  equal  emphasis  that  psychiatry  has  far  broader  contacts 
with  the  world  than  with  medicine  alone.  We  have  pointed 
out  that  mental  hygiene  is  in  some  ways  a  much  broader  topic 
than  medicine,  touching  education,  ethics,  the  legal  order,  and 
economics,  to  say  nothing  of  science,  art,  political  science,  re- 
ligion, and  philosophy.  Practically,  moreover,  the  field  of 
psychiatric  social  work  would  never  have  been  developed  in  its 
present  form,  had  it  not  been  for  the  labors  of  the  mental 
hygienists,  amongst  whom  we  must  count  not  psychiatrists 
only  but  also  psychologists.  Psychiatric  social  work  is  accord- 
ingly not  alone  a  logically  separate  division  of  social  work  but 
also  practically  a  separate  division,  as  defined  by  the  existence 
of  a  type  of  specially  trained  worker  and  as  defined  by  the 
history  of  the  movement  itself. 

It  is  plain  that  the  field  of  (a)  general  social  case  work 
stands  logically  somewhat  farther  apart  from  (&)  medical 
social  work  and  (c)  psychiatric  social  work  than  {h)  and  (c) 
stand  apart  from  each  other.  Indeed,  it  might  be  claimed  that 
psychiatric  social  work  is  nothing  but  an  important  subdivision 
of  medical  social  work  akin  to  such  subdivisions  as  the  tuber- 
culous, orthopedic,  lieart,  syphilis,  and  pediatric  subdivisions. 
In  fact,  this  claim  has  been  made  by  some  workers,  though 


THE    KINGDOM    OF    EVILS  383 

nowhere  supported  by  a  thorough  logical  and  historical  argu- 
ment. The  observer  must  bear  in  mind,  however,  that,  if  we 
are  talking  logic  alone,  the  public-health  movement  ought  to 
carry  in  its  front  lines  the  banner  of  mental  hygiene.  Public 
health  officers  and  specialists  in  preventive  medicine  ought  to 
have  developed  mental  hygiene  divisions  as  logically  and  as 
practically  as  they  have  developed  their  work  in  sanitation, 
bacteriology,  and  in  later  days  personal  hygiene.  But  the  pub- 
lic health  movement  has  never  taken  the  "person"  on  so  broad 
a  basis  as  the  individual  "person"  of  mental  hygiene.  What- 
ever the  public  health  movement  ought  to  have  been  or  ought 
to  have  become  in  relation  to  mental  hygiene,  the  facts  are 
against  anyone  who  should  claim  that  mental  hygiene  is  his- 
torically an  outgrowth  of  public  health.  So  it  is  with  the  move- 
ment for  psychiatric  social  work.  The  movement  is  derived 
from  psychiatric  clinics,  psychopathic  hospitals,  out-patient 
clinics  for  mental  and  nervous  diseases,  mental  hygiene  so- 
cieties, and  kindred  mental  hygiene  units  of  the  community. 
Perhaps  it  has  been  better  so.  The  man  interested  in  sanita- 
tion, bacteriology,  and  the  simpler  devices  of  so-called  personal 
hygiene  is  not  apt  to  be  a  person  profoundly  interested  in  social 
relationships  and  their  adjustment  and  readjustment.  The  per- 
son interested  in  economic  relief  and  primarily  in  the  solution 
of  the  comparatively  simple  problems  of  the  tuberculous,  the 
orthopedic,  the  "heart  cripple,"  and  even  of  the  sick  child,  is 
not  a  person  who  is  apt  to  give  due  weight  to  educational,  ethi- 
cal, and  legal  sides  of  her  problem,  having  in  mind  adjustments 
which  transcend  the  wage  intake  and  the  bodily  health  and 
comfort  of  the  sick  person. 

Now  it  is  perfectly  true  that  to  solve  the  problems  of  the 
lame,  the  halt,  and  the  blind,  or  of  the  tuberculous,  or  of  the 
child  sick-of-body,  the  bigger  and  more  complex  social  adjust- 
ments are  more  and  more  coming  to  be  regarded  as  indispen- 
sable. In  the  terms  of  the  future  history  of  social  case  work, 
we  may  safely  predict  that  the  psychiatric  point  of  view  will 
react  upon  the  general  medical  point  of  view  in  case  work. 
The  very  same  thing  is  happening  in  the  field  of  medicine  re- 
garded from  the  standpoint  of  the  physician.  The  general 
practitioner  of  medicine  in  every  parish  is  inevitably  busy  with 
psychiatric  problems,  though  he  may  not  think  of  them  as  such. 
Psychiatry  is  a  branch  of  medicine  every  whit  as  general  in 


384  THE    KINGDOM    OF    EVILS 

one  sense  as  is  the  general  practice  of  medicine  itself.  The 
nervous  system  penetrates  every  part  of  the  body  and  the  mind 
influences  every  diagnosis,  every  prognosis,  and  every  thera- 
peutic procedure  in  medicine.  Nevertheless,  it  will  be  a  num- 
ber of  years  before  the  general  practitioners  become  equipped 
with  the  psychiatry  they  need.  So  it  is  with  psychiatric  social 
work.  Psychiatric  social  work  is  bound  to  influence  medical 
social  work,  and,  in  fact,  all  forms  of  social  case  work.  Just 
as  the  general  practitioner  of  medicine  would  greatly  benefit 
by  getting  into  his  head  the  main  facts  about  psychiatry,  so 
the  medical  social  worker  will  equally  benefit  by  absorbing  the 
new  principles  of  psychiatric  social  work.  Logically  the  two 
fields  of  medical  social  work  and  psychiatric  social  work  pre- 
sent aspects  of  resemblance  and  aspects  of  difference.  His- 
torically the  two  fields  present  separate  lines  of  development. 
Practically,  even  at  the  present  day  we  must  insist  that  psychi- 
atric social  work  is  by  no  means  a  specialty  coordinated  with 
pediatric  or  orthopedic  social  work,  but  presents  a  body  of 
principles  applicable  alike  to  all  the  subdivisions  of  medical 
social  work. 

The  new  theories  of  social  work  or  practice  must  soon  effect 
changes  even  in  sociolog}^  as  a  whole.  Sociology  as  a  whole 
has  run  perhaps  too  much  to  a  schematic  and  general  account 
of  supposed  evolutionary  laws  of  the  nature,  structure,  and 
development  of  society.  In  this  general  account  of  society's 
evolution  commonly  called  sociology,  the  individual  is  very 
likely  to  get  named  on  page  one  but  not  to  figure  extensively 
in  the  table  of  contents.  We  claim  then  that,  by  beginning 
with  a  study  of  the  individual  in  his  finest  and  most  delicate 
deviations  from  the  normal,  we  are  starting  an  inductive  study 
which  if  carried  through  sedulously  will  react  upon  sociology 
itself  and  therefore  upon  political  science,  economics,  ethics, 
and  the  rest  of  human  interest.  Let  no  reader  say  that  this  is 
an  elaboration  of  the  obvious.  The  inductive  method  has  been 
on  the  cards  since  the  Novum  Organon  of  Francis  Bacon,  but 
inductive  progress  toward  a  completer  sociology  has  not  begun 
with  the  individual  and  especially  not  with  the  individual  as 
delicately  dissected  out  in  mental  disease. 

We  have  arranged  the  case  studies  of  this  work  in  a  certain 
formal  way.  For  the  most  part,  however,  we  have  presented 
them  so  that  each  stands  upon  its  own  feet.     Nor  do  we  think 


THE    KINGDOM    OF    EVILS  385 

that  the  data  have  been  essentially  modified  by  the  process  of 
analysis  to  which  they  have  been  subjected.  The  narratives 
are  chiefly  drawn  from  "intensive"  cases  in  our  hospital  files 
rather  than  from  cases  of  so-called  "slight  service."  The  data 
presented  are  condensed  to  even  far  less  than  one-tenth  of  their 
original  extent,  with  the  omission,  however,  of  no  important 
link  in  the  narrative,  taken  as  a  narrative.  The  book  might 
thus  be  read  purely  at  random  and  each  case  regarded  as  a 
source  of  texts.  We  have  constructed  the  index  to  the  book 
in  such  manner  that  many  of  these  texts  or  special  maxims  can 
be  studied  in  particular  cases,  even  where  no  attempt  has  been 
made  in  the  summary  to  unite  the  cases  to  demonstrate  par- 
ticular precepts. 

The  object  of  dividing  the  case  descriptions  of  the  book 
into  three  main  parts  was  a  purely  practical  one.  In  Book  I 
we  sought  to  show  the  main  spheres  of  influence  which  are 
brought  to  bear  upon  social  cases  in  civilized  communities 
where  (a)  government  and  (b)  systematic  voluntary  social 
agencies  and  (c)  special  methods  of  handling  the  individual 
are  highly  organized.  Book  II  is  devoted  to  a  much  more 
individual  analysis  of  the  social  cases  from  the  standpoint  of 
the  various  troubles,  difficulties,  maladjustments,  or  evils  that 
they  present.  The  analysis  of  Book  III  is  a  medical  analysis 
and  gives  some  slight  idea  of  the  varieties  of  social  diagnosis 
and  treatment  of  cases  falling  in  the  more  generally  recog- 
nized groups  of  mental  disease  and  defect. 

THE  METHOD  OF  BOOK  I  :  SPHERES  OF  INFLUENCE 

The  principle  upon  which  the  seven  cases  of  Book  I  are  pre- 
sented may  seem  a  novelty  in  social  work.  The  triple  division 
of  the  spheres  of  influence  under  which  social  cases  fall,  viz., 
public,  social,  and  individual,  corresponds  with  categories  of 
the  legal  order  as  developed  by  Dean  Roscoe  Pound.  Dean 
Roscoe  Pound's  forthcoming  work  on  Sociological  Jurispru- 
dence will  soon  unfold  a  logical  view  of  the  bases  of  this  triple 
division.  We  may  be  pardoned  for  remarking  more  super- 
ficially upon  the  division  in  these  pages.  The  usual  distinction 
between  "public"  and  "private"  is  still  of  practical  value,  de- 
spite the  unclear  line  which  may  separate  public  from  private 
duties  and  responsibilities.     The  term  "public,"  as  we  under- 


386  THE    KINGDOM    OF    EVILS 

stand  Dean  Pound,  might  well  be  restricted  to  the  operations 
of  organized  government,  which  is,  of  course,  a  part  of  society- 
taken  in  its  broadest  sense ;  but  the  operations  of  society  taken 
as  a  whole  are  essentially  non-governmental,  not  yet  organized 
into  state  affairs.  In  short,  there  are  a  great  many  of  the 
most  important  concerns  of  society  w^hich  are  not  acknowledged 
to  be  public  in  the  sense  of  governmental  affairs.  They  re- 
main "private,"  although  they  affect  social  groups.  In  default 
of  a  better  term  for  the  non-governmental  operations  of  social 
groups.  Dean  Pound,  as  we  understand  him,  proposes  to  use 
the  term  "social."  Social  operations  in  their  widest  sense 
would  then  include  governmental  operations  as  well  as  numer- 
ous others.  Whenever  we  are  talking  about  governmental  op- 
erations, however,  we  shall  almost  inevitably  want  to  dis- 
tinguish them  as  such,  and  we  may  appropriately  use  the  term 
"public"  for  these  more  fixed,  solid,  and  rigid  products  (fos- 
sils) of  the  social  development  of  bygone  days.  Dean  Pound 
developed  these  distinctions  in  a  discussion  of  the  interests  of 
personality  derived  from  a  reinvestigation  of  the  so-called 
"natural  rights"  of  man.  Into  that  deep  discussion  we  do  not 
care  to  penetrate.  We  simply  adopt  this  suggested  nomencla- 
ture for  the  agencies  and  other  spheres  of  influence  that  come 
in  contact  with  our  cases.  From  a  practical  point  of  view  the 
social  worker  must  soon  concede  the  influence  of  public  agencies 
in  this  special  sense  of  organized  governmental  agencies.  The 
fixity,  solidity,  and  rigidity  of  the  public  service  may  be  a 
virtue  or  a  fault  as  the  case  may  be,  but  in  any  event  nobody 
is  more  clearly  aware  than  the  social  worker  of  the  ex- 
istence of  these  obstacles  or  leverage  points  of  the  public 
service. 

But  we  also  distinguish  between  the  "individual"  and  the 
"group."  We  have  come  to  see  that  individualization  is  a 
leading  trend,  not  only  of  modern  social  work,  but  of  most 
departments  of  human  knowledge.  The  old  distinction  be- 
tween "public"  and  "private"  is  accordingly  no  longer  able  to 
serve  our  best  purposes.  We  need  to  build  up  the  idea  of  the 
private  into  the  idea  of  privacy  as  opposed  to  public  or  gov- 
ernmental responsibility — privacy  in  the  sense  of  what  James 
called  "the  warmth  and  intimacy"  of  the  individual  man. 

Thus  an  ancient  distinction  was :  public  7's.  private.  Another 
very  plain  distinction  is :     group  z's.  individual.     We  now  have 


THE    KINGDOM    OF    EVILS  387 

to  combine  logically  these  two  distinctions  and  the  results  are 
as  follows : 

^  /Public 

G^o"P  {social        1  p^.^^^^^ 
Individual/ 

For  practical  purposes  we  can  then  distinguish  the  interests  of 
our  cases  as  public,  social,  and  individual.  We  shall  never 
forget  that  in  the  present  state  of  advanced  civilization  in  the 
communities  where  social  work  flourishes,  no  individual  and 
no  social  agency  can  fail  to  be  affected  by  the  public  service  in 
some  fashion.  But  public  servants  can  and  do  forget  that 
their  responsibilities,  although  strictly  limited  by  law,  organi- 
zation, and  regulation,  are  surrounded  by  conditions  in  which 
the  responsibilities  of  social  groups  are  numerous  and  also  in 
some  respects  paramount.  Neither  the  public  officer  nor  the 
social  worker  should  forget  his  duties  to  the  individual  as  such. 

The  social  worker,  standing  as  she  does  midway  between 
public  service  on  the  one  hand  and  the  ideal  of  individual 
service  on  the  other,  must  not  remain  aloof  from  both.  She 
can  often  imagine  a  procedure  far  superior  to  any  now  afforded 
by  the  public  service  for  the  forcible  handling  of  a  given  case, 
yet  she  finds  the  public  sphere  of  influence  paramount. 
She  must  bow  to  the  public  service.  Her  recourse  is  so  to 
stimulate  social  opinion  that  it  shall  become  public  regulation. 

Looking  in  the  other  direction,  the  social  worker  may  often 
find  a  situation  in  which  she  feels  that  some  family  group  or 
neighborhood  group  would  be  greatly  benefited  by  a  particular 
invasion  of  individual  rights  and  a  particular  interpretation  of 
the  interests  of  this  individual  running  counter  to  his  desires. 
Persuasion  rather  than  compulsion  must  here  be  her  aim.  This 
persuasion  may  not  be  hers  to  attempt  or  to  carry  through ; 
that  persuasion  may  be  the  duty  of  some  physician  or  other 
adviser.  The  middle  ground  occupied  by  the  social  worker 
between  public  service  and  individual  desires  and  rights  is  a 
position  of  danger.  She  stands  in  that  middle  ground,  untram- 
meled  by  the  laws  and  regulations  of  the  public  service  and 
beyond  the  control  in  essential  ways  of  the  physician.  So  far 
as  law  and  medicine  are  concerned,  she  is  on  rather  neutral 
ground.  In  critical  and  limited  phases  of  her  work  she  is,  to 
be  sure,  governed  and  guided  by  judge  and  physician,  but  she 
has  every  chance  to  push  on  to  crises  and  limits  that  may  not 


388  THE    KINGDOM    OF    EVILS 

be  necessary  and  may  not  represent  the  "one  best  way."  She 
is,  as  has  been  remarked,  a  sort  of  professional  or  intensive 
layman.  It  may  be  that  a  judge  or  physician  would  do  no 
better  in  her  place  amongst  these  non-legal  and  non-medical 
problems;  but,  if  she  pushes  her  non-legal  and  non-medical 
problems  into  the  legal  or  medical  zone,  she  is  likely  to  be 
charged  with  causing  difficulties  when  she  has  merely  shaped 
their  course  toward  the  only  available  beacons.  Can  there  be 
any  doubt  of  the  importance  of  securing  men  and  women  of 
the  highest  grade  for  social  work?  Is  it  not  clear  that  they 
must  understand  the  main  principles  of  the  interrelation  be- 
tween medicine,  education,  morals,  law,  and  economics  ?  There 
used  to  be  much  discussion  as  to  what  might  be  given  if  we 
could  turn  the  problem  around.  Define  what  constitutes  a 
psychiatric  social  worker — the  "points"  of  such  a  worker 
would  then  correspond  with  those  of  the  so-called  "educated" 
man.  Elsewhere  we  give  a  summary  of  such  "points"  as  prac- 
tical experience  seems  to  agree  upon. 

So  much  then  for  the  raisoii  d'etre  of  Book  I.  It  will  be 
noted  that  there  are  seven  cases  in  Book  I.  When  three  terms, 
such  as  public,  social,  and  individual,  are  combined  in  eight 
ways,  the  eighth  combination  (logically  speaking)  is  that  situ- 
ation in  which  all  three  are  absent.  Accordingly  we  find  that 
to  illustrate  all  existent  combinations,  public,  social,  and  indi- 
vidual, we  need  but  seven  cases.  Book  I  also  serves  as  a  sort 
of  general  introduction  to  the  whole  topic,  and  we  have  placed 
in  the  discussions  of  the  seven  cases  of  Book  I  a  few  general 
remarks  that  apply  to  the  remainder  of  the  volume  as  well. 
But  what  we  especially  hope  to  drive  in  by  the  contentions  of 
Book  I  is  a  wholesome  respect  on  the  part  of  the  social  worker 
for  the  problems  of  the  individual  as  such  and  for  the  problems 
of  public  service  as  such.  If  she  does  not  like  all  aspects  of  the 
public  service  of  the  present  day  and  if  she  is  dissatisfied  with 
the  medical  and  other  knowledge  of  the  psychic  interiors  of 
her  patients,  she  must  not  kick  against  the  prick  of  judge  and 
administrator  in  public  matters  or  act  as  a  substitute  for  the 
physician  or  other  adviser  upon  matters  depending  upon  medi- 
cal diagnosis.  There  are  certain  interests  of  personality  to  be 
secured  by  the  legal  order  and  by  the  public  administrator. 
There  are  certain  aspects  of  personality  which  are  to  be  han- 
dled, so  far  as  they  can  be  handled,  by  the  best  expert  advisers 


THE    KINGDOM    OF    EVILS  389 

obtainable.  The  task  of  the  social  worker,  and  especially  of 
the  psychiatric  social  worker,  remains  a  morally  heavy  task — 
the  task  of  utilizing  the  fixities  and  fulcra  of  public  service  and 
at  the  same  time  the  delicate  and  elastic  values  of  the  expert 
in  personality.  Couched  in  these  terms  one  might  think  the 
psychiatric  social  worker  or  any  social  worker  must  be  some- 
thing celestial.  We  can  only  point  to  the  relative  successes  and 
instructive  failures  of  the  cases  presented  in  this  book  to  show 
that  there  is  no  celestial  claim  but  only  a  purely  practical  and 
human  claim  made  for  these  workers.  If  all  expert  work  in 
the  adjustment  of  personality  seems  to  be  rather  atmospheric 
and  if  the  public  service  seems  to  some  of  us  at  times  to  have 
become  a  solid  immovable  mass  then  we  must  thank  the  social 
worker.  She  remains  liquid.  She  is  the  ideal  being,  a  uni- 
versal solvent.  She  proves  herself  to  be  a  useful  intermediary 
in  whatever  field  her  path  finally  arrives. 

Whereas  the  considerations  of  Book  I  seem  more  novel  than 
they  actually  are,  the  arrangement  of  data  in  Book  II  is  actu- 
ally the  most  novel  feature  of  our  work.  How  far  the  divi- 
sion of  the  troubles,  difficulties,  maladjustments,  and  evils  of 
society  into  five  groups  is  a  sound,  enduring  division,  it  is  hard 
to  say.  This  is  not  a  textbook  of  sociology.  We  claim  a 
purely  practical  applicability  for  our  subdivisions.  The  data 
of  these  cases  were  not  secured  under  the  headings  so  presented. 
Since  the  collection  of  these  data  and  the  completion  of  this 
work  the  divisions  of  the  so-called  Kingdom  of  Evils  have  begun 
to  be  practically  used  in  social  work  by  many  workers  connected 
with  the  state  institutions  for  mental  diseases  in  the  Common- 
wealth of  Massachusetts.  Practical  lectures  upon  these  classi- 
fications have  been  given,  and  the  active  workers  have  brought 
their  data  to  the  conferences  for  discussion.  The  divisions 
seem  to  work  out  in  practice.  Surely  some  division  of  data 
is  better  than  no  division. 

Heretofore  social  case  records  have  often  proved  to  be 
nothing  more  than  ill-digested  narratives,  with  vast  accretions 
of  facts  hardly  analyzable  by  any  person  save  the  original  col- 
lector of  the  data.  The  case  worker  familiar  with  her  case 
might  in  the  end  be  able  to  give  a  fairly  competent  account  in 
narrative  form  of  her  case.  Of  course  the  self-consistent  nar- 
rative may  actually  miss  the  point.  We  have  frequently  seen 
maladjustments  set  down  to  the  score  of  ignorance  which  were 


390  THE    KINGDOM    OF    EVILS 

actually  due  to  f eeble-mindedness ;  sometimes  (though  seldom) 
feeble-mindedness  has  been  erroneously  suspected.  To  call  a 
purely  moral  defect  psychopathic  is  a  slant  which  psychiatric 
social  workers  early  in  their  practical  work  may  fall  into.  To 
call  clearly  psychopathic  phenomena  immorality  is  a  prevalent 
fault  amongst  laymen,  many  physicians,  and  very  many  public 
servants.  To  charge  any  or  all  of  these  difficulties  up  to  the 
account  of  poverty  is  perhaps  the  commonest  flaw  in  social 
analysis  in  the  world  at  large.  Just  as  the  "economic  factor 
in  history"  was  so  greatly  the  rage  some  decades  since,  so  the 
economic  factor  in  personal  life  has  been  greatly  overdone.  To 
be  sure  it  does  not  take  the  data  of  mental  hygiene  to  demon- 
strate that  poverty  is  not  the  main  cause  of  social  trouble. 
Social  work,  before  it  had  attained  the  psychiatric  range,  had 
long  ago  proved  to  its  own  satisfaction  that  much  more  was 
wrong  than  mere  economics.  In  fact  progress  from  philan- 
thropy to  social  work  was  no  doubt  largely  due  to  the  growing 
appreciation  of  the  fact  that  giving  alms  or  financial  relief  did 
not  go  far  to  solve  social  problems. 

THE  METHOD  OF  BOOK  II  :  KINGDOM  OF  EVILS 

The  method  of  Book  II  is  no  less  practical  than  that  of  Book 
I.  Book  I  treating  spheres  of  influence  over  social  cases  pre- 
sented the  cases  in  their  social  matrix,  as  confronted  by  the 
social  worker  looking  for  practical  results  in  a  workaday  world 
full  of  necessary  and  unnecessary  obstacles.  The  compulsions 
of  government,  the  suggestions  of  the  voluntary  social  agencies, 
and  the  intimate  lines  of  attack  upon  personality  were  reviewed 
in  the  seven  possible  forms  of  their  combination.  Book  I  thus 
endeavored  to  teach  the  social  worker  that  no  layman  can  set 
himself  up  against  the  power  of  government  and  law  with  any 
hope  of  success  in  the  concrete  instance.  On  the  other  hand, 
we  perceived  that  it  was  the  social  worker's  duty,  if  she  found 
her  patient's  trouble  intimate,  individual,  and  personal  in  its 
nature,  to  swing  the  whole  policy  of  treatment  at  once  to  the 
physician,  to  the  teacher,  to  the  spiritual  guide,  or  (often  the 
best  plan  of  all)  to  the  man  himself.  But  how  is  the  social 
worker  to  pull  apart  all  the  concrete  particular  and  special 
facts  and  surmises  about  the  patient,  to  the  end  of  judging 
whether  the  patient  is  best  given  over  to  physician,  teacher, 


THE    KINGDOM    OF    EVILS  39I 

moralist,  or  back  to  himself?  It  is  the  province  of  Book  II  to 
try  in  a  somewhat  novel  manner  to  give  the  social  worker  a 
practical  method  of  analyzing  the  facts  available. 

It  has  been  found  possible  to  present  this  method  of  analysis 
in  Book  II  in  the  form  of  thirty-one  cases.  We  pointed  out 
that  the  three  spheres  of  influence  discussed  in  Book  I  could 
mathematically  be  combined  in  eight  ways,  or  practically  in 
but  seven  ways,  since  the  eighth  was  the  null  class  in  which 
all  three  elements  were  absent.  The  five  great  groups  of  what 
we  term  the  Kingdom  of  Evils  must  likewise  mathematically 
combine  in  a  limited  number  of  ways,  namely  in  thirty-two; 
but  again  the  thirty-second  combination  would  be  that  com- 
bination in  which  all  five  groups  of  evil  would  be  absent.  Thus, 
after  we  had  sufficiently  described  thirty-one  instances  of  evil, 
(that  is,  in  the  combination  in  their  various  ways  of  five  forms 
of  evil),  we  might  reserve  the  thirty-second  compartment  for 
some  absolutely  normal  person,  if  there  be  such,  who  had  never 
undergone  any  form  of  evil  whatever !  It  is  very  convenient 
to  work  with  five  forms  of  social  difficulty  rather  than  with 
four,  with  six,  or  with  seven.  Had  we  been  dealing  with  four 
major  groups  of  social  trouble,  we  should  have  been  able  to 
get  on  with  but  fifteen  combinations,  that  is,  with  the  mathe- 
matically possible  sixteen  combinations  minus  one.  If  we  had 
practically  found  in  our  social  case  analyses  six  forms  of  evil 
we  should  have  been  compelled  to  describe  in  Book  II  no  less 
than  sixty-three  cases,  for  the  purpose  of  illustrating  all  pos- 
sible combinations  (sixty- four  minus  one).  And  if  the  world 
had  been  still  more  complex  and  had  yielded  up  seven  kinds  of 
trouble,  our  exposition  in  Book  II  would  have  had  to  contain 
no  less  than  one  hundred  and  twenty-seven  cases  (the  one 
hundred  and  twenty-eight  mathematically  possible  combina- 
tions minus  the  null  case  in  which  all  seven  kinds  of  trouble 
were  by  hypothesis  non-existent!). 

We  must  eternally  insist  that  such  analyses  as  we  make  in 
this  volume,  and  particularly  the  analyses  of  Book  II,  must  be 
made  after  all  the  facts  are  in  hand.  By  no  means  do  we 
lay  down  any  principle  to  the  effect  that  the  practical  social 
worker  shall  practically  collect  the  case  data  in  the  order  in 
which  these  data  are  later  to  be  analyzed.  It  might  be  signally 
unwise  to  fly  at  the  situation  with  questions  concerning  health, 
educational  status,  moral  trends,  legal  entanglements,  before 


392  THE    KINGDOM    OF    EVILS 

the  worker  had  got  in  hand  the  main  facts  about  the  economic 
level  of  the  case  or  of  the  family.  There  must  be  a  proper 
technique  of  approach  for  every  case  as  to  the  collection  of  the 
data.  Some  points  and  categories  in  this  connection  are  of- 
fered in  Richmond's  Social  Diagnosis.  We  offer  in  this  book 
no  especially  new  points  as  to  the  technique  of  the  collection 
of  social  data.  Especially  with  psychopathic  cases  the  appli- 
cation of  any  rigidly  set  method  for  the  collection  of  the  facts 
might  prove  injurious,  not  necessarily  to  the  patient  himself, 
but  to  the  accuracy  and  speed  with  which  the  data  are  collected. 
There  are  some  facts  which  only  the  extraordinary  authority 
of  the  courtroom  is  likely  to  extract.  There  are  other  facts 
which  a  judge,  however  learned,  can  never  hope  to  unearth  by 
the  tools  at  his  disposal.  Again  it  is  most  obvious  that  there 
are  many  facts  that  only  physician  or  pastor  in  consulting  room 
or  vestry  can  obtain.  Experience  also  abundantly  proves  that 
there  are  many  facts  that  physicians  and  pastors,  or  even  both 
together,  cannot  by  any  means  secure.  Some  of  these  facts 
the  social  worker,  especially  the  woman  worker,  can  elicit  by 
methods  which  cannot,  or  at  least  in  this  place  cannot,  be  de- 
scribed. And  we  are  quite  ready  to  admit  that  some  facts  can- 
not be  dragged  out  of  some  patients  by  wild  horses.  That 
experience  with  mental  cases,  stretching  over  a  period  of  sev- 
eral months  or  years,  gives  the  professional  social  worker  far 
more  insight  into  the  technique  of  quickly  securing  the  intimate 
facts  most  useful  for  the  patient's  successful  treatment,  cannot 
be  denied.  It  is  on  this  account  that  we  elsewhere  in  this  sum- 
mary insist  on  the  importance  of  placing  in  the  practical  por- 
tion of  every  social  worker's  training  a  certain  amount  of  ex- 
perience with  mental  cases.  We  shall  also  point  out  that  to  give 
the  proper  basis  and  background  for  the  interpretation  of  such 
experience  with  mental  cases,  the  ideal  curriculum  of  every 
social  worker  {zvhether  or  not  the  worker  is  going  practically 
into  the  field  of  psychiatric  social  work)  ought  to  contain  a 
strong  didactic  part  dealing  with  mental  diseases  and  defects 
and  including  the  mild  psychopathies,  eccentricities,  and  devia- 
tions from  the  normal.  Dr.  G.  L.  Walton  some  years  ago  en- 
deavored with  more  or  less  success  to  get  the  term  degenerate 
replaced  with  the  term  deviate.  Not  only  was  Walton's  new 
standpoint  theoretically  well  based,  but  there  was  nmch  prac- 
tical wisdom  in  these  suggestions  by  the  genial  author  of  Why 


THE    KINGDOM    OF    EVILS  393 

Worry.  For  it  is  much  easier  to  persuade  or  convince  an 
everyday  person  that  he  is  perhaps  a  Httle  deviate  than  to  show 
him  that  he  is  a  httle  degenerate !  In  short  not  only  v^ould  the 
mental  hygiene  of  the  social  worker  be  improved  by  a  study 
of  mental  cases  as  they  practically  occur  in  everyday  life,  but 
so  also  would  benefit  accrue  to  the  mental  hygiene  of  every- 
body else. 

Let  us  picture  the  social  worker  returning  from  the  day's 
work  in  a  reflective  state  of  mind.  Let  us  suppose  that  the 
social  worker  is  thinking  over  all  that  is  now  known  as  the 
result  of,  say,  twenty-five  hours  of  contact  first  and  last  with 
the  case  and  its  surroundings.  In  describing  the  method  of 
Book  II  in  a  practical  way  to  elementary  workers  at  the  outset 
of  their  training,  we  have  sometimes  recommended  to  them 
the  following  simple  device.  Let  the  worker  count  off  upon 
the  fingers  of  the  left  hand  (the  hand  conveniently  for  our 
present  purpose  called  sinister)  the  facts  as  conceived.  Upon 
the  thumb  let  there  hang  the  diseases  and  defects  of  the  patient 
and  of  related  members  of  the  family,  in  fact  all  more  or  less 
non-hygienic  features  of  the  situation,  including  very  particu- 
larly even  the  slightest  mental  disorder  or  defect.  Secondly, 
Tipon  the  index  finger  let  there  be  suspended  all  the  forms  of 
ignorance  which  the  patient  and  the  persons  around  him  ex- 
hibit, so  far  as  these  afifect  the  situation;  and  let  these  data 
include,  not  merely  lack  of  education,  language  difficulties  and 
the  like,  but  also  all  positive  misinformations  and  errors  of 
point  of  view,  so  far  as  these  are  of  intellectual  origin.  Upon 
the  longest  or  middle  finger  let  there  be  strung  whatever  there 
is  of  moral  defect  (of  course  not  psychopathic  and  not  merely 
a  matter  of  ignofance),  including  all  sorts  of  vices  and  bad 
habits  and  many  of  the  so-called  sins  of  theology  and  common 
sense.  Upon  the  ring  finger  there  may  be  placed  all  sorts  of 
legal  entanglements,  whether  in  the  nature  of  crimes  and  de- 
linquencies on  the  part  of  the  patient  or  on  the  part  of  his 
associates,  whether  actually  subject  to  court  review  or  poten- 
tially so  subject.  There  remains  the  little  finger  upon  which 
to  dispose  all  such  matters  as  pauperism,  poverty,  and  other 
forms  of  resourcelessness.  It  is  the  province  of  Book  II  to 
show  cases  combining  all  these  forms  of  social  trouble  in  vari- 
ous ways.  If  it  were  quite  certain  where  the  trouble  of  each 
concrete  case  should  be  classified,  the  task  would  be  relatively 


394  THE    KINGDOM    OF    EVILS 

simple.  For  example  in  practice  many  social  workers  are  in- 
clined to  ascribe  to  ignorance  much  that  ought  to  be  called 
feeble-mindedness.  Elsewhere  we  have  given  other  instances 
of  the  improper  placement  of  concrete  facts  in  these  groupings. 
Practical  experience  goes  a  good  way  towards  abolishing  these 
errors  of  the  social  worker.  The  didactic  part  of  any  curricu- 
lum can  never  be  counted  on  to  prevent  such  errors.  Frequent 
conferences  are  necessary  to  keep  the  workers  on  the  right  track 
during  their  practical  experience. 

Book  II  shows  the  advantage  of  considering  social  facts  in 
a  definite  order.  Everybody  will  concede  that  some  order  is 
better  than  no  order,  and  everybody  knows  that  a  brief  list  can 
be  borne  in  mind  better  than  a  long  list  of  categories.  We  do 
not  want  to  dogmatize  about  our  plan.  The  future  may  well 
yield  up  a  better  order  for  the  consideration  of  social  facts; 
but  we  are  inclined  to  prophesy  that  social  work,  so  far  as  it 
remains  a  systematic  and  scientific  affair,  will  surely  cling  to 
some  order  rather  than  no  order  in  its  analysis  of  the  facts 
in  hand.  Again  the  social  work  of  the  future  may  provide 
a  quite  different  list  of  categories  than  the  fivefold  list  of  evils 
discussed  in  Book  II;  but  we  are  inclined  to  predict  that  the 
final  list  chosen  by  the  perfected  art  of  social  work  will  not  be 
a  long  list  of  categories,  and  probably  not  much  longer  than 
our  own  fivefold  grouping.  The  very  fact,  which  was  pointed 
out  above,  that  six  items  would  require  sixty-four  separate  set- 
ups of  social  fact  to  illustrate  the  possible  combinations  of  the 
six  items,  means  that  the  social  worker  would  find  her  sixfold 
load  too  great  to  bear. 

Be  it  remembered,  as  developed  a  little  further  on  in  this 
summary,  that  oftentimes  the  difficulties  are  not  merely  sepa- 
rate items  added  to  one  another  to  form  a  mere  heap  of  sep- 
arate facts,  but  that  in  numberless  instances  the  evils  multiply 
themselves  into  each  other  in  a  bewildering  way.  Let  the  social 
worker  think  for  a  moment  of  the  extraordinary  complications 
which  may  ensue  when  poor  moral  training  is  combined  with 
psychopathic  trends.  In  the  body  of  the  book  we  have  abun- 
dantly demonstrated  the  production  of  social  difficulty  of  this 
higher  order.  A  patient  combining  in  himself  the  effects  of 
poor  moral  training  and  the  effects  of  psychopathic  tendencies 
may  fall  into  such  a  status  that  neither  measures  of  moral 
reform  nor  the  procedures  of  medical  treatment  will  serve  to 


THE    KINGDOM    OF    EVILS  395 

remove  any  important  fraction  of  the  trouble.  For  such  in- 
timate comphcations  of  combined  moral  and  psychopathic 
trouble,  the  experts  of  the  future  will  be  required  to  find  com- 
binations of  moral  and  medical  training  and  treatment  not  yet 
dreamed  of. 

We  must  acknowledge,  too,  that  the  perfect  art  of  social 
work  might  well  in  the  future  shorten  the  list  of  categories. 
There  is  a  widespread  tendency  amongst  social  thinkers  to  re- 
gard immorality  and  crime  as  forms  of  disease.  We  believe 
that  no  serious  philosopher  of  the  social  life  is  today  willing 
to  concede  that  either  vice  or  crime  is  in  the  bulk  ready  to  go 
over  to  the  group  of  diseases.  The  Vitia  and  the  Litigia  are 
not  soon,  if  ever,  as  a  whole  to  go  over  to  the  Morbi.  (We 
do  not  deny  that  many  instances  of  so-called  Vitia  really  be- 
long in  the  group  of  Morbi.  But  that  is  a  matter  of  erron- 
eous diagnosis  in  the  given  instance,  and  not  a  matter  of  scien- 
tific reclassification  of  Vitia  as  Morbi.  And  a  like  argument 
holds  for  various  Litigia.  It  is  worth  incidentally  consider- 
ing that  the  jurists  ought  increasingly  to  admit  that  many  of 
their  Litigia  or  conditions  of  being  "at-law,"  would  be  thor- 
oughly resolved  if  the  medical  and  mental  aspects  of  one  or 
more  parties  in  the  case  were  to  be  recognized.  Nor  are  signs 
lacking  that,  with  the  tremendous  increase  of  the  idea  of  in- 
dividualization in  at  least  the  criminal  part  of  the  law,  the 
jurists  will  come  to  see  the  point  of  psychiatry.)  But  we  must 
theoretically  allow  the  possibility  of  the  telescoping  of  our  list. 
If  the  list  could  be  telescoped  by  so  much  as  the  subtraction 
of  one  item — for  example,  the  item  of  poverty  and  the  like 
(what  we  here  call  Penuriae),  there  would  be  but  sixteen 
major  combinations  of  the  four  remaining  great  items  rather 
than  the  thirty-two  which  form  the  basis  of  our  studies  in 
Book  II  of  this  volume.  With  the  unlocking  of  great  and 
increasing  amounts  of  energy  from  the  universe  by  modern 
research,  there  can  be  no  doubt  that  pauperism,  poverty,  and 
other  forms  of  resourcelessness,  here  termed  Penuriae,  are 
undergoing  a  decline  slower  than  we  might  wish  but  faster 
than  some  congenital  pessimists  readily  acknowledge.  Some- 
one, the  other  day,  claimed  that  the  science  of  the  last  few 
hundred  years,  and  especially  of  the  last  century,  had  blessed 
the  human  being  on  the  average  with  an  amount  of  energy 
equal  to  that  of,  say,  some  thirty  body  slaves    (the  analysis 


396  THE    KINGDOM    OF    EVILS 

presumably  took  into  account  the  great  reservoirs  of  electric, 
chemical,  and  thermic  energy  which  we  see  displayed  about 
us  so  profusely,  though  perhaps  irregularly,  in  the  great  cities). 
Every  social  worker,  like  every  other  good  citizen,  should 
support  with  all  that  is  in  him  the  cause  of  scientific  research, 
to  the  end  that  more  and  more  energy  be  unlocked  from  the 
infinite  quantities  available  to  man.  A  doubling  of  the  amount 
of  energy  unlocked  in  the  last  few  hundred  years  ought  to 
diminish  the  tale  of  the  Penuriae  to  a  very  visible  degree. 
Available  slave  power  in  non-human  forms  would  bring  back 
at  least  the  memory  of  the  Golden  Age. 

For  the  moment,  no  social  worker  can  hope  to  put  the 
Penuriae  out  of  mind  or  to  lose  contact  with  any  other  of 
our  five  categories  of  social  evil.  To  be  sure,  in  large  sections 
of  the  American  community  there  is  less  and  less  evidence  of 
the  effect  of  raw  ignorance  or  of  the  result  of  any  other  forms 
of  the  group  that  we  have  called  Errores.  Literacy  rules 
in  many  communities  and  illiteracy  is  a  problem  that  can  be 
far  more  readily  surrounded,  it  would  seem,  than  the  problem 
of  the  vices  and  bad  habits  (Vitia)  or  of  many  forms  of  dis- 
ease ;  for  example,  cancer  and  mental  disease.  It  has  been  a 
matter  of  curious  observation  with  the  authors  how  relatively 
few  instances  of  the  pure  and  uncomplicated  effect  of  igno- 
rance could  be  found  in  the  Psychopathic  Hospital  material 
which  lies  at  the  basis  of  this  book.  Language  difficulties 
were  of  course  frequently  in  evidence.  The  misdeeds  of  quack 
doctors  and  their  advertisements  turned  up  now  and  again  in 
the  shape  of  misinformation  distinctly  hurtful  to  our  patients. 
Some  instances  of  the  evil  effect  upon  the  intellect  (as  well, 
of  course,  as  upon  the  morals)  of  the  movies  were  discovered 
in  certain  patients.  Sundry  housewives  had  plainly  not  been 
taught  the  rudiments  of  good  housekeeping  by  their  parents 
or  guardians,  and  extraordinary  success  in  their  social  treat- 
ment was  found  to  follow  the  education  of  these  patients  in 
very  simple  procedures.  Education  serves  to  remove  the  bodily 
filth  characterizing  sundry  immigrants,  so  that  the  members 
of  the  filial  generation  look  with  genuine  horror  on  habits  of 
the  parental  generation.  We  are  willing  to  acknowledge  cer- 
tain prejudices  born  doubtless  of  our  special  experience,  and  one 
of  these  prejudices  runs  in  the  direction  of  assigning  not  quite 
so  much  weight  to  the  virtues  and  importance  of  education  as 


THE    KINGDOM    OF    EVILS  397 

its  worthy  devotees  are  likely  to  assign.  We  here  allude  to  edu- 
cation in  its  narrower,  intellectual  sense,  rather  than  in  the 
broader  usage  of  education  to  cover  moral  as  well  as  mental 
factors.  Our  prejudice  runs  to  the  claim  of  far  greater  value 
for  moral  training  than  for  intellectual  teaching.  It  has  be- 
come a  commonplace  with  many  modern  observers  that  the 
senses  are  easier  to  educate  than  the  emotions  are  to  train. 
The  senses  are  after  all  a  somewhat  simpler  affair  than  the 
emotions;  for  the  latter  dig  very  deep  into  the  "skin  and  its 
contents."  Those,  however,  who  observe  the  wonderful  re- 
sults of  animal  training  whether  by  the  technique  of  terrorism 
or  by  the  technique  of  tact,  can  only  be  optimistic  as  to  the 
powers  of  man  to  form  character.  Man  can  no  doubt  form 
character  more  easily  than  he  can  reform  character.  Man 
can  build  and  turn  his  temperament  in  a  variety  of  ways  far 
more  easily  than  he  can  reform  and  divert  his  temperament 
after  its  dilapidation  or  distortion. 

Up  to  this  point  we  have  argued  that  some  arrangement 
of  social  facts  was  better  than  no  arrangement,  that  a  short 
list  was  superior  to  a  long  list,  and  that  a  further  abbreviation 
of  our  present  list  was  devoutly  to  be  hoped  for  but  hardly 
to  be  expected.  Let  us  now  ask  the  further  question,  Is  there 
a  warrant  for  terming  the  present  list  of  five  forms  of  evil 
a  sequence  rather  than  a  list?  If  some  order  is  better  than 
no  order,  why  do  the  forms  of  evil  listed  as  we  list  them  fall 
into  this  particular  sequence?  The  particular  sequence  we 
have  adopted  is  a  much  more  doubtful  affair  than  the  prin- 
ciple of  the  sequence  itself.  The  social  thinker  might  well 
accept  the  principle  of  the  sequence  of  evils  in  this  book  with- 
out wanting  to  adopt  the  order  chosen.  Why  should  the  social 
worker,  it  might  be  questioned,  always  begin  with  the  topic 
of  disease?  Why  not  begin  with  the  topic  of  morals,  or  the 
topic  of  poverty,  as  being  the  prime  logical  factor  in  the  par- 
ticular case  in  hand?  Of  course  nobody  will  doubt  for  a 
moment  that  psychopathic  hospital  material  by  and  large  de- 
mands and  must  demand  prime  consideration  for  disease. 
Indeed  it  is  plain  that  medical  social  work  as  a  whole  demands 
prime  consideration  for  disease,  if  only  because  the  patients 
that  come  up  for  social  treatment  are  sick  patients.  But,  the 
general  social  worker  may  inquire,  why,  in  the  non-medical 
and  non-psychiatric  field,  should  the  consideration  of  disease 


398  THE    KINGDOM    OF    EVILS 

SO  inevitably  come  up;  and  why  in  particular  should  we  think 
of  disease  in  the  beginning  rather  than  in  some  subordinate 
place?  There  are  a  number  of  good  reasons  that  we  might 
adduce  for  our  choice.  For  example,  we  might  claim  that 
the  social  worker  who  fixes  her  mind  on  the  illiteracy  in  the 
social  situation  so  frequently  forgets  the  feeble-mindedness 
or  slight  subnormality  of  her  patient  (or  even  of  several  mem- 
bers of  the  family)  that  all  sorts  of  effects  get  erroneously  laid 
at  the  door  of  ignorance  rather  than  of  mental  defect.  If  a 
social  worker  gets  firmly  fixed  in  mind  at  the  outset  of  her 
work  some  apparent  instances  of  the  effect  of  ignorance,  she 
may  never  during  the  rest  of  her  social  work  be  able  to  forget 
that  initial  concrete  instance.  She  gets  dazzlingly  in  mind  the 
idea  of  education  for  all,  thinking  that  education  will  solve 
every  problem  of  apparent  ignorance  as  well  as  every  problem 
of  real  ignorance.  But  if  this  selfsame  social  worker  raises 
the  question  of  feeble-mindedness  or  subnormality  in  the  situa- 
tion she  faces,  she  will  time  and  again  be  rewarded  with  a 
point  of  view  entirely  new  to  her;  that  is,  with  a  medical  and 
mental  point  of  view,  which  as  a  child  and  in  her  youth  she 
had  no  means  of  grasping. 

Again,  there  are  still  social  workers  who  have  their  minds 
fixed  on  pauperism,  poverty,  and  other  forms  of  resourceless- 
ness  (in  this  book  summed  up  under  the  term  Penuriae)  and 
leap  to  the  explanation  by  defect  of  wages  or  compensation 
of  all  the  difficulties  in  the  case.  We  hinted  above,  this  idea 
was  no  doubt  the  idea  in  the  minds  of  the  earlier  philan- 
thropists. Although  no  doubt  the  early  workers  in  the  field  of 
social  science  in  our  country  recognized  that  not  all  history 
could  be  given  an  "economic  interpretation,"  yet  the  supporters 
of  philanthropy  were  perhaps  more  informed  with  the  idea 
of  helping  out  the  resourcelessness  of  their  less  fortunate 
brethren  than  penetrated  with  the.  ideal  of  consciously  altering 
the  entire  hygienic,  educational,  moral,  and  legal  orders. 
Financial  relief  is  today  so  much  more  obvious  than  legal  aid, 
moral  training,  intellectual  teaching,  and  medical  care,  that 
not  a  few  workers  virtually  stop  in  their  minds  with  the  idea 
of  monetary  aid  for  their  problems.  At  least  we  can  help  out 
with  money,  is  their  feeling.  With  money  we  can  get  for  our 
sick  ones  proper  medical  care.  As  for  education,  that  is  now 
largely  a  matter  of  public  service.     How  barren  and  abstract 


THE   KINGDOAI    OF   EVILS  399 

seem  the  suggestions  for  moral  training  and  legal  counsel  that 
we  have  to  offer!  There  is  no  doubt  a  certain  truth  at  the 
bottom  of  this  idea  of  primacy  of  so-called  "poor  relief"  in 
social  work.  We  are  all  aware  that  even  in  the  advanced 
community  where  a  charity  organization  approaches  perfec- 
tion, there  are  very  many  instances  in  which  pauperism  or 
severe  degrees  of  poverty  fail  to  get  duly  met.  Such  situa- 
tions in  rural  communities  can  almost  be  left  to  the  unin- 
structed  neighbor.  In  the  urban  community,  the  organization 
of  charity  is,  so  far  as  poor  relief  is  concerned,  undeniably  a 
statistical  success  in  places.  (We  do  not  here  refer  to  any 
questions  of  the  general  raising  of  the  wage  level  or  of  other 
methods  than  wage-control  for  establishing  the  entire  com- 
munity on  a  higher  terrace  of  wealth  and  resourcefulness.  We 
can  only  hope  that  in  the  end  the  slumless  condition  of  cer- 
tain of  our  middle  western  towns  and  cities  can  be  made  to 
extend  the  world  over,  perhaps  by  the  process  of  scientific  in- 
vestigation, for  which  the  National  Research  Council,  de- 
veloped in  our  country  during  the  war  and  paralleled  by  simi- 
lar organizations  in  several  belligerent  countries,  so  boldly  and 
efficiently  stands.)  But  we  are  entirely  sure  that  the  social 
worker  who  leaps  to  the  idea  of  poor  relief  is  rather  apt  to 
get  breathlessly  impaled  thereon.  She  is  apt  to  remain  quite 
incapable  of  giving  due  emphasis  to  the  possibility  of  these 
other  factors,  of  disease,  of  ignorance,  of  immorality,  and  of 
legal  entanglement,  as  vv^hole  or  partial  causes  for  the  out- 
standing poverty.  We  felt  compelled  practically  to  place  the 
Penuriae  at  the  bottom  of  our  sequence  of  evils. 

Assuming  that  the  Penuriae,  that  is,  poverty  and  other 
forms  of  resourcelessness,  may  well  be  placed  at  the  bottom 
of  our  sequence,  is  it  not  possible  to  argue  that  some  other 
group  than  the  Morbi  (diseases)  ought  to  be  placed  first? 
Certainly  not  ignorance,  as  was  above  argued  but — and  here 
we  approach  the  crux  of  many  faulty  points  of  view,  to  our 
thinking — would  it  not  be  wiser  to  consider  any  given  par- 
ticular bad  social  situation  as  probably  the  effect  of  immoral- 
ity or  of  bad  habits,  rather  than  of,  say,  disease?  Should 
not  the  Vitia  head  the  list?  Everybody  who  has  passed 
through  childhood  at  all  recently  or  has  the  childhood  experi- 
ence vividly  in  mind,  knows  and  feels  the  immense  and  almost 
universal  values  of  moral  training,  and  almost  everybody  finds 


400  THE   KINGDOM    OF   EVILS 

in  his  life  a  smaller  or  larger  trace  of  some  great  moral  mis- 
take touching  some  portion  of  his  life.  Most  of  us,  as  the 
years  travel  on,  get  a  bit  of  cynicism  or  a  slice  of  fatigue  about 
our  own  possible  reformation  of  character.  But  we  see  vari- 
ous persons  about  us  whose  characters  are  undergoing  a  trans- 
formation and  we  are  irresistibly  led  to  think  how  these  neigh- 
bors of  ours  might  rather  cleverly  be  reformed  by  simple 
devices,  and  how  many  of  them  might  have  their  characters 
built  and  molded  anew  with  the  proper  models  for  imitation 
and  the  proper  tools  of  training  in  hand.  If  our  neighbor 
gets  drunk  we  think  of  him  as  probably  addicted  to  a  vice — 
the  vice  of  inebriety.  We  do  not  at  the  very  first  inquire 
whether  he  has  not  some  character  defect  or  is  not  the  victim 
of  some  early  misapprehension  as  to  the  values  of  a  little  wine. 
If  the  neighbors'  children  write  impossible  legends  on  our 
backyard  fences,  we  are  apt  to  regard  the  children  as  vicious, 
and  we  do  not  charitably  trace  out  the  ignorance  of  their 
parents  or  even  the  feeble-mindedness  of  parents  or  children. 
We  feel  that  the  perpetrators  of  these  vices,  these  ''sinners," 
ought  to  be  morally  trained  or  reformed.  We  know  instances 
of  the  successful  training  or  reformation  of  just  such  persons. 
We  run  to  the  hypothesis  of  immorality,  vice,  or  bad  habits 
forthwith,  and  practically  on  a  basis  of  our  own  experience. 
We  see  in  these  "sinners"  precisely  ourselves,  and — charitably 
or  maliciously,  according  to  our  natures — we  would  like  to 
have  these  persons  given  what  in  our  American  slang  is  some- 
times termed  a  "course  of  sprouts."  Now  "sprouts"  is  a  most 
optimistic  term  for  the  plight  of  our  neighbors,  who  may  be 
in  no  condition  to  allow  the  new  growth  of  moral  ideas  by 
reason  of  mental  twist  or  lack,  by  reason  of  mere  ignorance 
of  the  socially  good.  Now  it  is  plainly  most  uncharitable  and 
itself  well-nigh  a  form  of  immorality  to  charge  up  vice  and 
sin  to  a  mentally  defective  or  merely  ignorant  person.  It  is 
the  charitable  and  right  thing  to  raise  the  hypothesis  in  every 
serious  case  of  social  maladjustment  whether  the  center  of  the 
situation  may  not  be  medical  (and  often  actually  psychopathic) 
or  mental  (in  the  sense  of  misinformation  on  the  part  of  the 
supposedly  sinful  or  immoral  person).  It  is  assuredly  not 
more  "insulting"  to  charge  an  alleged  sinner  with  disease, 
bodily  or  mental,  than  to  charge  him  with  vice  or  sin.  To 
be  sure,  the  layman  when  he  thinks  of  disease  is  rather  apt 


THE    KINGDOM    OF    EVILS  4OI 

to  think  of  severe  disease,  and  when  he  thinks  of  moral  defect, 
he  is  apt  to  think  of  mild  defect.  This  is  no  doubt  because  he 
bears  in  mind  only  his  own  severe  diseases  and  only  his  own 
mild  moral  difficulties.  In  short,  the  average  citizen  thinks 
of  disease  with  a  feeling  of  terror,  and  of  vice  with  a  leaning 
towards  exculpation.  He  thinks  of  himself  as  just  a  little 
sinful  and  of  his  neighbors  as  equally  excusable. 

But  whether  this  ethical  account  of  the  average  citizen's 
attitude  on  these  matters  be  a  correct  one  or  not,  there  is  to 
our  minds  no  doubt  in  the  world  that  the  serviceable  formula 
for  the  social  worker  to  bear  in  mind  is  to  think  of  each  social 
situation  as  possibly  bearing  within  it  a  kernel  of  disease,  espe- 
cially of  mental  disease,  and  particularly  of  the  mildest  forms 
of  mental  disease  known  as  temperamental  deviations  and 
mere  eccentricities.  If  the  social  worker  analyzes  her  situation 
from  the  standpoint  of  these  contained  kernels  of  mild  mental 
deviation  and  eccentricity,  she  will  gradually  lose  the  terrors 
associated  with  the  idea  of  insanity,  and  will  more  and  more 
adopt  the  attitude  of  William  James,  which  we  discussed  at 
length  at  the  beginning  of  this  summary.  She  will  get  the 
psychopathological  point  of  view  which  the  keen  spirit  of  the 
late  Carleton  Parker,  himself  not  at  all  medical  in  training,  got 
from  his  practical  contacts  in  living  amongst  laborers  and 
miners.  Carleton  Parker,  though  an  economist,  got  the  point 
of  what  might  be  termed  the  "psychopathic  interpretation  of 
history"  as  opposed  to  the  long  famous  "economic  interpreta- 
tion of  history."  Nor  will  the  reader  of  this  book  mistake 
our  meaning  when  we  use  the  phrase  "psychopathic  interpreta- 
tion of  history."  We  do  not  mean  an  interpretation  of  history 
as  a  product  of  psychopaths.  We  mean  that  history  (at  all 
events,  the  history  of  our  individual  instances  of  maladjust- 
ment) can  best  be  interpreted  by  the  technique  which  starts 
from  the  outset  to  observe  the  minor  deviations  and 
variations,  the  differences  and  the  contrasts,  rather  than 
the  similarities  and  the  analogies  that  so  fill  the  mind  of 
the  observer  of  "averages." 

There  will,  we  think,  be  far  less  objection  to  our  ordering 
of  other  factors  than  the  ones  just  discussed ;  namely,  the  or- 
dering of  Penuriae,  the  Morbi,  and  the  Vitia.  If  a  man  is 
not  in  full  possession  of  his  bodily  and  mental  health,  it  is 
just  a  little  idle  to  discuss  at  length  the  quantity  of  his  knowl- 


402  THE    KINGDOM    OF    EVILS 

edge  and  the  quality  of  his  wisdom.  But  if  a  person  is  not 
mentally  healthy  and  reasonably  well  informed,  no  doubt  in- 
quiries as  to  his  moral  turpitude  are  a  bit  futile.  Again,  if 
we  do  not  know  a  man's  health,  education,  and  morals,  how 
can  we  adjudge  the  nature,  cause,  effect,  and  manner  of 
extrication  of  his  legal  entanglements?  Finally,  if  we  do 
not  know  the  medical  data,  the  educational  status,  the^moral 
tendencies,  and  the  civil  standing  of  the  man,  how  can  we 
sensibly  talk  about  his  economic  level? 

We  assume  that  the  reader  is  now  thoroughly  convinced 
that  some  order  in  social  case  analysis  is  better  than  no 
order;  that  a  short  list  of  categories  is  better  than  a  long 
list ;  and  that  our  sequence  has  a  good  deal  to  recommend 
it,  both  from  the  practical  standpoint  of  psychiatric  and  med- 
ical work,  and  from  sundry  more  general  standpoints.  But  a 
more  general  question  may  be  raised.  Why  do  we  advocate 
the  analysis  of  evils  at  all?  Why  discuss  liabilities  instead 
of  assets?  Why  discuss  negatives  instead  of  positives?  We 
might  answer  and  remain  content  with  the  answer,  that  it  all 
amounts  to  the  same  thing,  and  that  what  looks  like  a  re- 
mainder is  as  a  matter  of  fact  a  sum.  Or  again,  we  might  an- 
swer that  much  depends  upon  the  point  of  view.  That  is,  we 
might  say  that  some  persons  like  to  analyze  from  the  side  of 
evil,  and  others  like  to  analyze  from  the  side  of  good,  and 
that  we  are  writing  for  those  who  prefer  in  the  first  instance 
to  slay  dragons  rather  than  to  seek  the  Grail.  No  doubt  we 
should  be  on  very  safe  ground  if  we  claimed  the  existence  of 
these  two  temperaments ;  the  temperament  of  the  dragon- 
slayers  and  the  temperament  of  the  Grail-hunters.  Moreover, 
we  might  point  out  that  the  dragon-slayers  have  perhaps  in 
the  past  secured  as  many  Grails  as  those  who  started  Grail- 
hunting  from  the  first. 

IV 

COMPARISON  OF  THE  KINGDOM  OF  EVILS  WITH  OTHER  SCHEMES 
OF   SOCIOLOGICAL  ANALYSIS 

Our  attention  has  been  called  to  a  formula  of  Malthus,  re- 
sembling in  its  categorization  our  own  grouping  of  the  evils. 
Malthus,  like  his  father  (a  friend  and  executor  of  Rousseau) 
was  in  a  sense  a  perfectibilian.     He  thought  that  societies  tend 


THE    KINGDOM    OF    EVILS  4O3 

to  happiness  but  have  been  checked  by  miseries  due  to  an  in- 
crease of  population.  He  showed  that  the  positive  checks  to 
the  increase  of  population  were  war,  vice,  crime,  disease,  and 
poverty.  Four  of  these  five  Malthusian  checks  upon  the  in- 
crease of  population  roughly  correspond  with  four  of  our  own 
categories.  It  will  be  easy  to  show,  we  think,  that  war  is  in 
itself  by  no  means  a  category  quite  so  simple  as  any  of  the 
other  four.  No  doubt  also  Malthus  would  have  been  happy 
to  acknowledge  that  ignorance  was  a  great  cause  of  an  over- 
increase  of  population.  Indeed  Malthus  or  any  other  theorist, 
following  Socrates,  might  well  feel  that  ignorance  lay  at  the 
bottom  of  several  of  our  own  categories.  Population  some- 
times increases,  sometimes  decreases.  It  would  be  equally 
easy  to  show,  we  think,  that  either  the  Malthusian  five  cate- 
gories or  our  own  might  be  as  capable  of  decreasing  popula- 
tion as  of  increasing  it.  To  claim  that  the  increase  of  popula- 
tion or  the  decrease  of  population  is  in  itself  an  evil  is  some- 
thing like  the  claim  that  superficial  thinkers  might  make  that 
war  is  an  evil.  It  is  indeed  unwise  to  assert  that  any  condi- 
tion is  or  is  not  intrinsically  an  evil.  It  is  far  better  to  weigh 
observed  conditions  or  factors  in  the  light  of  a  set  of  categories 
like  the  ones  suggested. 

Malthus,  it  will  be  recalled,  used  the  phrase  "struggle  for 
existence"  in  relation  to  social  competition.  Here  again 
is  a  phrase  that  suggests  that  a  given  condition  can  be  set 
down  as  essentially  an  evil  or  as  essentially  a  good.  The  idea 
that  the  struggle  for  existence  was  not  all  happy  was  repug- 
nant to  sundry  theologists,  when  Darwin  gave  reflected  luster 
to  Malthus  in  his  new  contentions  concerning  evils.  On  the 
other  hand  it  would  seem  that  German  thinkers,  say  of  the 
Ernst  Haeckel  stripe,  might  w^ell  find  the  struggle  for  exist- 
ence in  no  sense  an  evil,  but  think  it  rather  a  good. 

It  seems  to  us  that  this  concept  of  the  struggle  for  exist- 
ence also  will  greatly  benefit  from  an  analysis  of  what 
might  be  called  its  evil  constituents.  We  might  find  that 
the  pathology  of  the  individual  was  a  negligible  factor  in  that 
development.  We  might  fi.nd  the  struggle  for  existence  a 
function  of  intellectual  development  in  different  species  and 
describe  it  in  plain  terms  in  an  attractively  simple  fashion.  We 
might  note  the  moral  values  of  the  struggle  for  existence  or 
again  the  vicious  effects  of  centering  one's  life  upon  rnere 


404  THE    KINGDOM    OF    EVILS 

existence.     We  might  study  law  and  order  in  its  lowest  terms 
(insect  life)    or  work  upon  the  human  level,  and  again  find 
components  of  a  constructive  and  beneficent  nature  and  com- 
ponents of  a  destructive,  maleficent  nature.     The  field  of  eco- 
nomics would  also  blossom  under  this  double  analysis.     Dar- 
win believed  that  the  struggle  for  existence  greatly  aided  man 
and  that  his  rapid  multiplication  was  largely  responsible  for 
his  success  in  the  world.     He   fully  conceded  the  values  of 
these  moral  influences  that  in  the  end  supersede  the  simpler 
factors.     Still,  even  upon  the  moral  level,  Darwin  was  inclined 
to  depreciate  measures  which  would  reduce  the  natural  ratio  of 
increase  for  man.     On  the  whole,  he  took  an  anti-Malthusian 
view  of  man's  multiplication  in  the  world.     A  blanket  view 
of  the  evils  or  of  the  excellence  in  to  to  of  increase  or  decrease 
of  population  within  prescribed  limits  is,  no  doubt,  apt  to  be 
an  erroneous  view.     The  analyst  will  benefit  himself  and  the 
world  if  he  clearly  conceives  in  his  own  mind  whether  he  is 
analyzing  for  forms  of  evil  or  for  forms  of  goodness  in  the 
heap  of  factors  that  he  sees  before  him.     Having  made  his 
major  decision   as  to   whether   he    is    studying   the   negative, 
privative,  and  destructive  factors  or  the  positive,  additive,  and 
constructive  factors  in  his  world,  the  analyst  will  further  bene- 
fit by  an  orderly  approach  in  his  study  of  particular  situations. 
The  five  checks  of  Malthus  upon  the  increase  of  population 
which  we  found  so  nearly  to  correspond  with  our  own  five 
categories  were,  no  doubt,  not  original  with  Malthus.     Many 
of  his  arguments  were  derived  from  thinkers  like  David  Hume, 
Adam  Smith,  and  Montesquieu.     The  same  set  of  categories 
with    various    additions    will    be    found    amongst    modern 
writers.     Thus  Small  classifies  the  interests  of  man  un-'^er  six 
headings ;    namely,     health,    wealth,    sociability,    knowledge, 
beauty.  Tightness.     It  will  be  observed  that  these  six  cate- 
gories fairly  well  correspond,  though  in  a  different  order,  with 
our  own  five  categories. 

We  have  omitted  any  craving  for  beauty  and  its  lack  of 
satisfaction  from  amongst  our  categories,  not  because  it  is 
non-existent,  but  because  to  the  practical  adult  ugliness  seems 
not  to  be  a  primary  or  highly  important  evil  in  the  world  of 
social  difficulty.  Small  himself  can  find  hardly  more  than  a 
paragraph  of  ideas  concerning  the  beauty  interest  of  man ;  he 
quotes  from  Schiller  and  is  virtually  clone.     There  seems  to 


THE    KINGDOM    OP    EVILS  4O5 

be  no  completed  esthetic  theory  amongst  philosophical  doc- 
trines even  at  the  present  day.  The  majority  of  the  esthetic 
dissatisfactions  which  we  have  found  in  our  social  case  work 
can  rather  readily  be  placed  amongst  the  Errores  as  matters 
of  misinterpretation  or  misinformation:  in  fact  that  Platonic 
theory  of  beauty  which  reduces  it  to  a  kind  of  harmony  is  a 
theory  very  consistent  with  the  practical  placement  of  the 
ugliness  evil  in  our  group  of  Errores,  but  in  any  event  the 
esthetic  dissatisfaction  is  at  the  present  day  wholly  upon  a 
practical  level  of  investigation.  Small  quotes  from  Emerson's 
essay  on  Resources  an  interesting  passage  which  we  give  be- 
low, a  passage  which  also  omits  from  its  categories  the 
esthetic.  This  is  the  more  remarkable  as  Emerson  was  doubt- 
less more  a  litterateur  than  a  philosopher  or  at  all  events  was  a 
I'itterateur  of  first  magnitude. 

Ross  has  quarreled  with  Small's  groupings  on  a  variety 
of  grounds.  He  sees  the  main  interests  in  man,  hunger  and 
love,  as  specific  demands  of  man,  not  at  all  to  be  covered  in 
under  the  designation,  "desire  for  health,"  and  points  out  that 
health  is  more  of  a  sine  qua  non  than  an  object  of  desire  as  an 
end.  Concerning  the  latter  point  we  would  commend  the 
placement  of  health  first  in  Small's  series  of  desires — a  place- 
ment analogous  to  our  own  placing  of  the  Morb'i  at  the  head 
of  our  own  list.  Furthermore  we  would  take  advantage  of 
Ross's  critique  of  Small  to  point  out  that,  when  the  morbid 
side  of  nutrition  and  of  reproduction  comes  into  view,  Ross's 
objection  to  Small's  grouping  to  a  great  extent  falls  away. 
We  may  not  regard  hunger  and  love  as  items  in  our  health 
program,  but  when  there  is  disease  affecting  nutrition  and 
reproduction,  certainly  these  particular  categories  do  impera- 
tively cry  for  attention. 

The  desire  for  wealth  (Ross  again  asserts)  is  not  a  pri- 
mary desire  but  depends  upon  a  still  more  fundamental  opera- 
tion of  the  ego  (so-called  egotic  desires  of  Stuckenberg)  ;  but, 
if  we  approach  the  wealth  or  economic  question  from  its  nega- 
tive and  privative  side  {i.e.,  from  the  standpoint  of  what  we 
had  termed  the  Penuriae  or  resourcelessnesses)  we  shall  find 
that  by  changing  our  point  of  view  we  have  escaped  this  par- 
ticular critique.  The  desire  for  wealth  may  not  "dififer  in 
principle,"  as  Ross  says,  "from  the  lust  of  lordship  over  per- 
sons   (power),   or   lordship   over   man's   admiration    (glory), 


406  THE    KINGDOM    OF    EVILS 

or  lordship  over  man's  judgment  (influence)"  ;  but  where  there 
is  absolute  resourcelessness,  the  very  ego  itself  is  hindered  in 
its  progress.  Resourcelessness  hurts  life,  as  one  may  say, 
more  than  increasing  resourcefulness  helps  life.  This  is  at 
least  true  on  any  particular  level  of  attainment.  By  setting 
the  mind  on  the  sort  of  Grail  that  some  men  take  wealth  to  be, 
we  may  miss  various  dragons  of  resourcelessness  that  could  be 
readily  slain. 

Ross  objects  to  Small's  category  of  sociability  on  the 
ground  that  the  craving  for  companionship  is  one  sort  of  thing 
and  an  eagerness  for  appreciation  quite  another  sort  of  thing. 
But  again  consider  this  phenomenon  of  sociability  in  its  nega- 
tive form  (as  one  might  say,  dissociability).  The  craving  for 
no  companionship  amounts  to  an  almost  psychopathic  trend  of 
seclusiveness,^  or  is  at  all  events  a  vicious  attitude  or  bad  habit 
which  helps  neither  the  race  nor  the  individual.  Again  an 
absence,  like  an  excess,  of  desire  for  appreciation  would  form 
an  important  attitude  of  viciousness  or  a  bad  habit  sometimes 
developed  in  degree  or  kind  almost  to  the  point  of  mental 
disease. 

Concerning  Small's  categories  of  knowledge  and  rightness, 
Ross  makes  no  particular  objection.  We  can  see,  then,  that, 
in  general,  Ross's  strictures  concerning  Small's  categories  can 
be  readily  avoided  by  change  of  point  of  view  from  the  analysis 
of  those  interests  as  positive  to  an  analysis  of  them  in  their 
negative  or  privative  form.  Had  Small  taken  the  pathological 
view  he  would,  we  think,  have  uncovered  rich  leads  in  the 
analysis  of  society. 

The  passage  from  Emerson  mentioned  above  is  at  the  end 
of  his  essay  on  Resources  and  runs  as  follows : — 

"But  the  one  fact  that  shines  through  all  this  plenitude  of 
powers  is,  that,  as  is  the  receiver,  so  is  the  gift;  that  all  these 
acquisitions  are  victories  of  the  good  lirain  and  ])rave  heart ; 
that  the  world  belongs  to  the  energetic,  belongs  to  the  wise.  It 
is  vain  to  make  a  paradise  for  good  men.  The  tropics  are  one 
vast  garden ;  yet  man  is  more  miserably  fed  and  conditioned 
there  than  in  the  cold  and  stingy  zones.     The  healthy,  the 

CIVIL,    THE    INDUSTRIOUS,    THE    LEARNED,    THE    MORAL    RACE 

Nature  herself  only  yields  her  secret  to  these.  And 
the  resources  of  America  and  its  future  will  be  immense  only 
to  wise  and  virtuous  men." 

'  The  name  of  a  familiar  symptom  in  psychiatry. 


THE    KINGDOM    OF    EVILS  407 

There  are  thus  five  kinds  of  thing  that  are  essential  in  the 
Emersonian  search  for  Nature's  secret.  But  it  is  interesting 
to  note  the  order  in  which  Emerson  has  put  the  assets  of  the 
favorites  of  Nature.  He  gives  the  honorable  first  and  last 
places  to  health  and  morality,  but  as  he  sums  up  the  whole 
situation  concerning  the  resources  of  America  in  the  future 
he  considers  that  wisdom  and  morality  are,  after  all,  the  great- 
est aids  to  the  unlocking  of  the  immensest  resources  of  his 
country.  Health  he  too  would  regard  as  indispensable  and 
may  on  this  account  put  it  first  amongst  the  qualities  of  the 
race  to  which  Nature  will  yield  her  secret.  That  a  race  shall 
be  civil,  that  is  a  race  under  government  and  law — here  also 
is  an  indispensable  rather  than  an  essential  from  Emerson's 
standpoint.  To  be  industrious  was  doubtless  also  to  the  New 
England  mind  of  Emerson  a  mere  indispensable  rather  than 
an  essential.  Upon  the  basis  of  three  indispensables, 
health,  civic  order,  and  industry,  Emerson  builds  the  more 
essential  science  and  morals. 

The  Emersonian  ordering  of  these  five  categories  is  as  well 
thought  out  as  it  is  sublime  in  implications.  The  Emersonian 
order  is,  no  doubt,  the  important  order  leading  from  the  in- 
dispensables to  the  essentials  in  human  endeavor.  But,  from 
the  standpoint  of  the  analysis  of  a  world  run  down  or  of  a 
bad  social  situation,  it  may  w^ell  be  that  this  order  is  not  the 
best  one.  Lack  of  health  remains  a  primary  consideration,  but 
ignorance,  misinformation,  and  misinterpretation  have  far 
wider  scope  than  the  operations  of  organized  law  and  indeed 
are  found  at  work  in  the  innermost  sanctums  of  private  life, 
where  they  destroy  morality,  render  legal  advice  useless  or 
harmful,  and  are  a  prolific  source  of  resourcelessness  in 
themselves. 

To  be  healthy,  wealthy,  and  wise  is  the  desire  expressed  in 
an  ancient  adage.  To  be  healthy  is  as  always  indispensable ; 
but  hardly  any  reflective  person  would  rather  be  wealthy  than 
wise.  For  our  part  we  are  inclined  to  place  education  next 
in  order  upon  the  indispensable  lower  layer  of  health,  not  be- 
cause virtue  has  really  been  proved  to  be  knowledge,  but 
because  without  a  healthy  and  trained  intelligence  it  is  im- 
possible to  meet  successfully  the  complex  moral  problems  that 
compose  so  large  a  part  of  the  field  of  social  work,  not  to  say 
of  the  world's  work  so  far  as  it  concerns  the  individual. 


40S  THE    KINGDOM    OF    EVILS 

DEFINITIONS  OF  THE  FIVE  GROUPS  OF  EVILS 

We  have  thought  it  worth  while  to  set  down  in  a  special 
part  of  this  general  discussion  some  approximate  definitions 
of  evil  and  its  major  groups.  Elsev/here  we  refer  briefly 
to  certain  philosophical  viewpoints  about  the  nature  of  evil  in 
general.  Here  our  statement  must  confine  itself  to  a  few 
phrases. 

The  term  evil  itself  seems  to  be  related  in  root  to  the  words 
up  and  over.  Ev  and  ov  of  evil  and  over  respectively  stand 
very  close  from  the  standpoint  of  those  who  investigate  the 
origin  of  words.  Apparently  evil  carries  within  itself  more 
the  idea  of  excess  than  of  defect.  This  would  be  the  nat- 
ural view  of  the  early  thinkers  and  word-makers  since  they 
would  naturally  people  evil  situations  with  something  super- 
added in  the  nature  of  spirits  or  demons.  In  fact,  in  the  field 
of  disease  itself  in  relatively  recent  times  there  has  been  a  ten- 
dency to  ascribe  disease  to  an  Archeus  or  an  Incubus,  that  is 
to  something  thrown  in,  as  it  were,  on  top  of  the  situation. 

By  far  the  greater  number  of  terms  which  we  use  for 
evil  are  used  for  positive  qualities  although  there  are  a  good 
many  privative  ones.  Thus  to  be  evil  (following  the  Century 
Dictionary)  is  to  be  merely  "depraved,  bad,  wicked,  vicious"; 
or  again,  to  be  "harmful,  hurtful,  mischievous,  prejudicial,  mis- 
leading, boding  ill";  or  again,  "causing  discomfort,  pain,  or 
trouble" ;  or  again,  "unfortunate,  miserable,  wretched" ;  or 
again,  "as  in  reference  to  misfortune,  sorrowful,  bad  luck,  dis- 
aster." Several  of  these  terms  are  positive  from  one  aspect  and 
negative  (or  privative)  from  another,  but  apparently  the  ma- 
jority of  the  words  are  used  in  the  positive  sense.  We  do  not 
need  to  take  a  philosophical  attitude  towards  the  existence  of 
evil  as  such  in  the  world.  Even  if  there  were  philosophically 
no  evil,  still  these  named  conditions  would  exist  to  be  met  in 
some  way  or  other. 

There  are  also  a  variety  of  privative  meanings,  such  as  the 
meaning  of  being  insane,  that  is  of  having  an  "evil  head"  or 
again,  "unwholesome,  of  inferior  quality,  poor,  unsatisfactory, 
defective,  unskillful."  Evil,  in  general,  is  censurable,  mischiev- 
ous, undesirable,  painful,  disastrous,  and  the  like.  It  is  in- 
teresting to  note  that  the  term  "ill"  is  the  same  as  the  word 
evil  by  a  natural  omission  of  the  consonant  "v."     We  would 


THE    KINGDOM    OF    EVILS  409 

especially  insist  that  we  should  not  like  to  have  the  term  evil 
used  for  specific  evils  where  it  is  possible  to  give  it  a  more 
exact  and  specific  term  such  as  are  to  be  found  under  the  major 
subgroups  that  we  describe.  The  theologians  say  that  the  term 
"evil"  is  likely  to  become  obsolete.  Yet  it  is  used  in  a  number 
of  important  places  in  the  Bible.  For  example,  in  Genesis  we 
hear  of  the  tree  of  knowledge  of  good  and  evil.  In  the  second 
book  of  Esdras  the  evil  is  broken  in  pieces  and  the  good 
created. 

It  will  be,  as  a  rule,  a  confession  of  relative  ignorance  con- 
cerning the  fact  if  all  we  can  say  of  a  situation  is  that  it  is  a 
bad  one,  that  it  is  a  maladjusted  situation,  that  it,  so  to  speak, 
belongs  somewhere  in  the  Regnmn  Malorum.  We  must 
specify  further.  Our  point  in  speaking  of  definitions  is  to 
insist  that  the  majority  of  evil's  meanings  in  a  practical 
workaday  sense  of  the  term  refer  to  positive  rather  than 
to  privative  badness  of  situation. 

(a)  Morhi:  Diseases  and  Defects  of  Body  and  Mind 

As  to  disease,  this  term  upon  its  face  looks  like  a  priva- 
tive term  for  lack  or  absence  of  ease,  and  such  terms  as 
uneasiness,  pain,  distress,  trouble,  and  discomfort  are  synony- 
mous of  the  term  as  used  outside  of  pathology.  Huxley  terms 
disease  as  "perversions  of  normal  activities  of  a  living  body"; 
but  a  question  might  here  turn  upon  what  is  normal  activity 
of  a  living  body.  Sometimes  we  try  to  define  disease  quanti- 
tatively. We  seek  to  show  that  it  means  an  excess  of  some- 
thing or  a  defect  of  something.  We  gather  valuable  data 
about  disease  from  the  weights  and  measures  of  the  organs 
and  tissues  and  the  plotting  of  curves  and  their  reactions.  But 
those  same  weights  and  measures  and  to  some  extent  the  curves 
of  reactions  may  be  found  in  the  dead  as  well  as  in  the  living 
organism  of  constituent  part  of  the  organism. 

Another  way  in  which  it  has  been  attempted  to  define  dis- 
ease is,  first  to  describe  some  norm,  pattern  or  model  or  struc- 
ture and  function,  to  which  a  body  and  its  organs  are  supposed 
to  conform.  Here  it  is  not  so  much  a  question  of  weights  and 
measures  of  the  body  and  its  organs  as  of  the  conformity  of 
these  weights  and  measures  to  some  standard  set.  The  stand- 
ard body  and  the  standard  organs  that  constitute  it  are  de- 


4IO  THE    KINGDOM    OF    EVILS 

veloped  perhaps  by  some  evolutionary  process.  The  hypoth- 
esis would  be  that  that  body  or  organ  survived  which  was 
of  greatest  use  in  the  struggle  for  existence  of  the  species  own- 
ing such  a  body  and  such  constituent  organs  or  tissues. 

On  the  whole  perhaps  it  is  best  to  define  disease  as  an  inter- 
ference with  the  life  of  the  body  or  of  any  part  thereof  or 
with  the  persistence  of  any  activity  or  function  of  the  body 
and  its  constituents.  Thus  disease  interferes  with  life  of  the 
body  as  a  whole,  which  lives  or  dies.  But  again  disease  may 
affect  entire  organs  and,  though  it  destroy  them,  may  not  de- 
stroy life  unless  these  organs  are  (as  we  say)  capital  organs. 
But  the  organs  are  made  up  of  tissues,  great  portions  of  which 
may  die  and  be  either  partially  or  not  at  all  replaced  by  re- 
generative processes.  Herein  would  be  an  example  of  disease 
and  recovery  with  defect.  There  are  constituent  factors  of 
safety  in  the  make-up  of  the  total  organism,  so  that  many 
elements  of  it  may  die  without  death  of  the  whole.  Disease 
may  doubtless  affect  even  the  smallest  cell  of  the  body,  though 
the  study  of  such  minute  processes  of  health  and  disease  is  a 
difficult  one.  But  the  lay  student  must  not  get  too  much  in 
mind  the  idea  of  an  organism,  an  organ,  a  tissue,  a  cell  in 
the  structural  aspects  of  all  things.  He  must  likewise  think 
of  disease  as  affecting  function,  of  the  curves  of  response  to 
certain  stimuli  as  damagingly  in  excess  or  in  defect.  The 
holding  fast  to  this  idea  of  the  functional  in  disease  is  particu- 
larly necessary  in  the  field  of  mental  disease,  where  so  many 
of  the  entities  have  not  been  proved  to  be  due  to  loss  of 
structure. 

The  difference  between  a  structural  and  a  functional  disease 
is  hard  to  define.  We  have  spoken  of  disease  as  an  interfer- 
ence with  the  life  of  vital  units  (like  the  cell  tissues  or  organ) 
and  as  interference  with  the  persistence  of  a  given  function 
such  as  breathing,  the  heart  beat,  or  the  food  exchange  in 
tissues.  Professor  Royce  once  remarked  that  almost,  if  not 
quite,  the  total  meaning  he  could  extract  from  the  term  func- 
tional was  the  idea  of  reversibility.  A  functional  disease  is, 
on  this  definition,  a  disease  whose  phenomena  are  reversible 
to  the  state  antecedent  to  the  perturbing  factor.  To  ask, 
then.  Is  the  present  situation  a  reversible  one?  is  often  of 
practical  value. 

Disease,  then,  consists  of  an  interference  with  the  life  of 


THE    KINGDOM    OF   EVILS  4II 

living  Structure  or  interference  with  the  persistence  of  func- 
tions of  those  living  structures.  In  the  former  event  there  is 
apt  to  be  something  discoverable  by  the  microscope,  by  the 
more  or  less  elaborate  methods  of  the  pathological  laboratory. 
In  the  latter  event,  that  is,  in  the  case  of  the  interference  with 
the  persistence  of  vital  functions,  there  may  be  nothing  micro- 
scopically to  be  found ;  perhaps  even  theoretically  nothing  need 
be  found  by  the  microscope  in  pure  perturbations  of  function. 

(b)    Err  ores:   Educational   Deficiencies  and   Misinformation 

Let  us  turn  to  a  definition  of  the  Err  ores.  Probably  we 
have  often  spoken  of  our  group  of  Err  ores  under  the  English 
term  "ignorance."  The  Err  ores  do  indeed  contain  a  large 
fraction  of  pure  ignorance  whether  in  the  shape  of  mere  lack 
of  education  or  in  the  shape  of  an  immigrant's  not  knowing 
the  language  of  the  country  of  his  adoption.  But  the  Errores 
contain  positive  as  well  as  negative  terms.  A  man  may  be 
not  merely  uneducated  but  actually  maleducated  in  that  he  has 
been  given  actual  misinformation.  So  far  as  the  maleducated 
man  is  concerned,  we  may  say,  it  is  no  fault  of  his  (that  is, 
we  do  not  lay  it  up  against  any  vice  or  bad  habit  of  his  or 
charge  it  up  to  disease).  To  be  sure,  his  teacher  may'have  been 
mentally  deficient  or  twisted,  or  may  have  been  the  victim  of 
some  vice  or  bad  habit  of  thought,  or  may  have  harbored  a 
vicious  design  in  teaching  him  certain  things.  But  from  the 
standpoint  of  the  maleducated  man  himself,  he  belongs  in  the 
group  of  Errores  in  an  analysis  of  the  total  situation.  His 
psychopathic  or  vicious  teacher  would  have  to  fall  in  other 
categories  than  those  of  Errores.  But  a  still  more  important 
sub-group  of  Errores  exists.  A  man  may  be  not  merely  un- 
educated or  maleducated,  but  he  may  be  a  victim  of  misappre- 
hension or  given  to  misinterpretation.  To  be  3ure,  any  pro- 
longed trend  toward  misapprehension  or  misinterpretation 
would  doubtless  throw  one  into  some  psychopathic  group. 
Practically  there  would  be  hardly  any  difficulty  in  determining 
that  degree  or  kind  of  error  which  falls  within  the  adage  "To 
err  is  human."  We  do  find  the  inexperienced  social  worker 
charging  up  to  ignorance,  misinformation,  and  misinterpreta- 
tion much  that  belongs  in  the  field  of  feeble-mindedness.  With 
a  little  more  experience,  the  social  worker,  as  elsewhere  inti- 


412  THE    KINGDOM    OF   EVILS 

mated,  may  swing  too  far  in  the  other  direction  and  find 
feeble-mindedness  where  there  has  been  nothing  but  lack  of 
education  or  maleducation.  Common  blunders  and  mistakes, 
as  well  as  logical  fallacies  of  reasoning,  belong  in  this  group 
of  the  Err  ores,  where  they  do  not  argue  mental  disease  itself. 

When  Sir  Benjamin  Brodie  says  that  much  of  the  evil  which 
exists  in  the  world  may  be  traced  to  mere  ignorance,  he  is, 
no  doubt,  functioning  as  an  optimist.  As  social  workers  we 
must  see  to  it  that  we  hew  to  the  line  in  both  directions.  Let 
us  never  be  content  with  ascribing  the  situation  for  long  as  a 
mixture  of  feeble-mindedness  and  ignorance.  Let  us  analyze 
these  constituents  of  maladjustment  and  try  to  cure  or  com- 
pensate the  one  and  educate  or  reeducate  the  other. 

In  the  dictionaries  we  can  find  a  number  of  phrases  that 
indicate  the  sort  of  thing  that  should  be  included  under  the 
Err  ores,  such  as  experience,  lack  of  information,  misappre- 
hension, misinformation,  malinstruction,  no  schooling,  poor 
schooling,  deception,  sophistry,  unsoundness  of  argument,  mis- 
taken notions,  false  belief,  delusion  (sane),  inaccuracy,  am- 
biguity, illiteracy,  blunder,  misinterpretation.  Sometimes  the 
term  error  is  used  in  a  moral  sense  to  indicate  a  wrong  doing 
or  transgression,  but  to  ascribe  a  sin  to  a  mere  wandering  from 
the  path  is  to  take  away  from  the  sin  most,  if  not  all,  of  its 
responsibility;  it  is  an  over-charitable  way  of  viewing  a  sin 
or  vice  in  the  eye  of  the  ordinary  man. 

(c)   Vitia:  Vices  and  Bad  Habits 

We  now  come  to  that  which  we  shall,  no  doubt,  fail  to  de- 
fine thoroughly,  namely  the  group  of  the  J'^itia.  One  advan- 
tage of  the  Latin  names  here  adopted  is  that  they  are  rather 
more  comprehensive  than  any  single  English  equivalent.  Thus 
the  Morbi  we  use  to  include  not  only  disease  in  the  narrower 
sense  but  also  defect  and  anomaly.  Again  we  are  using 
Err  ores  not  only  in  the  negative  sense  of  ignorance,  but  in  the 
more  positive  sense  of  misinformation  and  misinterpretation. 
Again  Vitia  is  a  term  which  we  intend  to  use  more  compre- 
hensively to  cover  not  merely  vices  but  also  bad  habits.  Thus 
we  can  see  that  not  merely  the  most  opprobrious  vices  but  also 
such  a  bad  habit  as  laziness  about  brushing  one's  teeth  are  to 
be  included  under  the  Vitia.     There  is  an  extremely  long  list 


THE    KINGDOM    OF    EVILS  413 

of  synonyms  and  variants  upon  the  ideas  of  vice  and  sin  which 
we  do  not  here  reproduce.  It  will  repay  the  reader  to  consult 
a  good  dictionary  and  trace  down  a  large  number  of  these  con- 
ceptions to  their  final  ramifications  in  meaning.  We  have  not 
used  the  term  sin  to  any  extent  in  this  book,  because  we  have 
regarded  this  term  as  a  theological  term  and  have  not  cared 
to  venture  into  the  debatable  questions  of  the  kinds  and  de- 
grees of  theological  sin.  Still,  in  a  practical  view,  we  regard 
most  of  the  sins  as  falling,  socially  speaking,  into  our  group 
of  the  Vitia.  Some  of  them,  no  doubt,  in  old  times  and  in 
certain  theological  systems  of  the  present  day  would  fall  into 
a  field  of  ecclesiastical  jurisprudence  (penance  questions  and 
the  like)  and  therefore  belong  in  our  group  of  the  Litigia,  but 
these  considerations  have  nothing  to  do  with  the  main  thread 
of  our  argument,  which  is  quite  innocent  of  theology. 

A  practical  question  to  lodge  when  one  wants  to  decide 
whether  a  thing  is  a  disease,  a  matter  of  error  (in  our  special 
sense),  or  belongs  amongst  the  Vitia,  is  the  following:  Is  this 
factor  something  I  should  like  to  cure  in  a  medical  sense 
of  the  term  cure?  or  is  it  something  I  am  fain  to  meet  by  a 
process  of  reeducation?  or  again  is  it  a  factor  subject  to  some 
process  of  reformation?  We  try  to  prevent  disease  or  to 
cure  it.  We  try  to  .avoid  ignorance  and  misinterpretation  by 
teaching  or  by  so-called  reeducation.  We  try  to  train  for  the 
moral  life  or  to  reform  the  immoral.  The  pragmatic  question 
what  ought  to  be  done  at  this  point  is  often  the  successful  step 
in  analysis.  If  you  can't  help  wanting  to  reform  Tom's  char- 
acter, whereas  you  want  to  reeducate  Dick's  intellect  and  are 
fain  to  cure  Harry's  mental  deficiency,  you  may  find  that  you 
are  unconsciously  on  the  right  track  when  elaborate  final 
analysis  will  fail  you. 

(d)  Litigia:  Legal  Entanglements 

As  for  the  Litigia,  here  is  a  knotty  question  which  presum- 
ably none  but  jurists  should  strive  to  answer.  It  is  a  nice  ques- 
tion whether  being-at-law  actually  or  potentially  is  always  an 
evil.  The  legal  order  seeks  to  secure  a  variety  of  interests, 
many  of  which  are  of  positive  significance  to  the  man  or  the 
community.  But  nevertheless  we  conceive  that  being-at-law, 
whether  in  or  out  of  court  and  whether  in  esse  or  in  posse  is 


414  THE    KINGDOM    OF    EVILS 

in  some  sense  a  maladjustment.  Somehow  the  whole  connec- 
tion of  the  law  is  that  of  a  process  for  securing  order  where 
there  was  disorder.  There  may  be  a  legal  order  which  is  of 
purely  positive  and  constructive  value  to  the  world.  If  so  we 
should  exclude  its  processes  from  our  group  of  the  Litigia. 
Litigia  is  a  term  which  is  much  broader  than  most  terms  for 
legal  situations.  Its  usage  accordingly  allows  the  inclusion  of 
arbitration  and  other  processes  of  law  outside  of  the  judiciary. 
Apparently  it  is  the  best  term  available  for  the  situations  we 
are  here  attempting  to  designate.  A  delinquent  falls  into  this 
group,  but  delinquency  on  the  part  of  somebody  else  than  the 
patient  makes  also  a  situation  of  litighim.  There  need  be  no 
moral  attributes  (although  there  may  be  such)  in  a  contro- 
versy against  the  law.  Ignorance  is,  as  we  say,  no  excuse  in 
the  eyes  of  the  law,  so  that  one  may  still  be  involved  in  Litigia 
even  though  one  has  been  ignorant  of  automobile  ordinances. 
One  may  inherit  legal  difficulties  as  in  the  celebrated  case  in 
Dickens  of  Jarndyce  vs.  Jarndycc. 

Enough  has  been  said  to  indicate  the  breadth  of  this  con- 
cept of  Litigia,  which  runs  altogether  beyond  the  considera- 
tions even  of  law  books  on  personal  relations  and  domestic 
relations.  General  social  work  and  much  of  ordinary  medical 
social  work  may  fail  to  show  much  sign,  of  the  Litigia,  but 
the  moment  one  gets  into  any  serious  family  situation  or  into 
any  complication  of  mental  disease,  there  is  apt  to  appear  a 
smaller  or  larger  trace  of  legal  entanglement.  The  whole  con- 
cept should  be  subject  to  a  proper  definition.  No  doubt  this 
proper  definition  will  obtain  when  sociological  jurisprudence 
has  been  further  developed. 

Let  us  review  instances  of  Litigia  that  appear  in  this  vol- 
ume. In  thirty-five  of  our  one  hundred  cases  legal  entangle- 
ment of  some  sort  is  a  major  factor  of  the  social  difficulty. 
Minor  considerations  of  legal  interest  enter  into  another  four- 
teen cases, — questions  of  legal  commitment  (cases  47,  75,  76, 
yy,  79,  85)  ;  also  matters  potentially  legal  that  never  developed 
to  the  point  of  legal  action,  such  as  instances  of  illegitimacy 
(cases  36,  48,  52,  66),  non-support  (case  78),  desertion  (cases 
32,  74),  pilfering  (case  25).  There  are  then  in  this  book 
forty-nine  cases  of  possible  interest  to  jurists.  We  list  below 
the  forms  of  Litigia  presented  in  these  cases : — adoption,  case 
12 ;  adultery,  case  8 ;  alcohol  and  drugs,  cases  58,  61,  63  ;  arson, 


THE    KINGDOM    Ol^    EVILS  4I5 

case  9;  assault,  case  97;  cohabitation,  case  81;  commitment, 
cases  47,  75,  y6,  yy,  79,  85;  damage  suit,  case  7;  deportation, 
cases  I,  5;  desertion,  cases  32,  74;  sex  disguise,  case  23; 
divorce,  cases  13,  17;  forgery,  cases  2,  80;  guardianship,  case 
70;  illegitimacy,  cases  36,  48,  52,  66;  juvenile  delinquents,  cases 
20,  31,  65,  84;  murder,  case  54;  neglected  child,  case  22;  non- 
support,  cases  4,  2)7 y  7^;  pilfering,  case  25;  sexual  assault, 
cases  15,  92;  stealing,  case  3;  technical  deserter,  case  29;  va- 
grancy, cases  51,  y2;  "work  or  fight,"  case  26;  workmen's  com- 
pensation, cases  II,  19,  90. 

{e)  Penuriae:  Poverty  and  Other  Forms  of  Resourcelessness 

We  have  insisted  throughout  upon  the  fact  that  our  group 
bi  Penuriae  includes  not  merely  poverty  in  the  everyday  sense 
of  that  term  but  also  all  other  forms  of  resourcelessness,  which 
can  be  defined  as  belonging  to  any  one  of  the  other  categories. 
A  man  might  be  wealthy  in  the  technical  sense  of  a  bank  ac- 
count, but  be  placed  in  a  desert  or  on  an  inaccessible  island. 
He  would  be  then  resourceless.  In  the  wake  of  wars  such  non- 
pecuniary  resourcelessnesses  are  to  be  found. 


ERRORES 

Trust  in  Inadequate  Authority 
Force  of  Custom 
Opinion  of  Inexperienced  Crowd 
Parading  of  Superficial  Wisdom 


CAUSES    OF    ERROR 

It  was  Roger  Bacon  (c.  1214-c.  1294)  who  dealt  systemat- 
ically with  the  causes  of  error ;  namely,  the  four  Offendicula. 
These  causes  of  error  were:  (i)  trust  in  inadequate  authority, 
(2)  force  of  custom,  (3)  opinion  of  the  inexperienced  crowd, 
(4)  concealment  of  real  ignorance  by  a  parading  of  superficial 
wisdom.  Of  these  four  errors  the  fourth  was  to  Roger 
Bacon's  mind  the  most  dangerous.  The  concealment  of  down- 
right ignorance  by  a  pretense  of  knowledge  was  perhaps  the 
cause  of  all  the  others.  Apparently  Bacon  had  no  doubt  that 
some  kind  of  knowledge  would  be  available  to  everyone.  What 
he  feared  far  more  was  the  foisting  upon  the  world  misin- 
formation; he  apparently  felt  that  the  fourth  of  the  Offen- 
dicula, the  parading  of  superficial  wisdom,  would  not  in  itself 
produce  error  had  not  the  thinker  been  somewhat  deceived. 
Why  should  one  (i)  trust  in  inadequate  authority,  (2)  be 
overawed  by  the  force  of  custom,  (3)  follow  the  opinion  of 
the  unskilled  many,  (4)  be  cheated  by  a  pretense  of  knowl- 
edge, if  there  were  not  a  certain  weakness  of  mind  in  the 
recipient  of  the  false  ideas.  Put  another  way,  the  stumbling- 
blocks  to  knowledge  that  Roger  Bacon  tried  to  chart  reduce 
largely  to  a  false  or  weak-willed  attitude  in  the  thinker.  Over- 
weening authority,  the  cake  of  custom,  the  herd  instinct,  in- 
tellectual fraud,  would  probably  not  be  effective  were  it  not 
for  a  certain  frailty  of  will.  In  short,  to  modern  analysis  the 
stumbling-blocks  of  Roger  Bacon  are  at  least  in  a  large  meas- 
ure inside  the  stumbler's  mind.  The  victims  of  what  we  might 
term  "raw  ignorance"  will  be  fewer  and  fewer  to  the  close  in- 
vestigator of  the  causes  of  error.  The  Errores  of  our  own. 
classification  tend  to  flow  over  into  the  Morhi  in  the,  form;  oft- 
greater  or  lesser  degrees  of  pathological  weak-willednesSi 
(aboulia,  hypoboulia)  or  over  into  the  Vitici:  in-  the  form  of^ 
over-compliances  with  authority,  easy-going  habits  of  thought, 
following  the  crowd,  facile  deception  by  those  who,  in  modern 
phrase,  are  "putting  it  over."  Possibly  this  tendency  of  mod- 
ejn,  science  to  classify  the  obstacles  to  knowledge  under  the 

419 


420  THE    KINGDOM    OF    EVILS 

heading  of  mental  or  moral  disorder  rather  than  as  plain  errors 
due  to  ignorance,  misinformation,  or  misinterpretation  will 
explain  why  we  find  in  our  social  patients  so  little  that  unre- 
servedly flows  into  the  group  of  Errores.  We  quote  Sir  Ben- 
jamin Brodie  to  the  effect  that  the  world's  evil  might  largely 
be  traced  to  mere  ignorance — this  we  might  grant  as  also  the 
truth  of  the  formula  "virtue  is  knowledge."  But  ignorance 
and  other  obstacles  to  knowledge  turned  out  so  frequently  to 
be  inborn  or  acquired  mental  disorder  or  character  defect 
or  ingrained  moral  defect  that  Sir  Benjamin's  formula  sounds 
to  the  modern  ear  a  bit  hollow. 

Francis  Bacon  (c.  1561-c.  1626)  has  yet  another  fourfold 
classification  of  the  general  causes  of  error  in  the  human  mind. 
He  laid  them  down  so  as  to  clear  the  path  for  the  introduction 
of  the  new  method  pf  science  which  he  was  to  advance.  The 
doctrine  of  fallacies  appears  in  final  form  in  the  Novum 
Organon  as  the  four  Idola.  The  first  of  the  Idola  bears  some 
resemblance  to  his  namesake's  stumbling-blocks, — the  opinion 
of  the  unskilled  many;  these  are  the  Idola  Trihus,  idols  of  the 
tribe,  fallacies  to  which  the  human  race  is  one  and  all  subject. 
But  for  that  matter  it  would  seem  that  all  of  the  Offendicula 
of  Roger  Bacon  might  well  be  put  under  the  tribal  fallacies 
of  Francis  Bacon.  When  we  looked  at  the  second  kind  of 
Idola  of  Francis  Bacon  we  saw  how  much  more  modern  is  the 
point  of  view  of  Baron  Verulam.  The  Idola  Speciis,  the  idols 
of  the  cave  (probably  here  is  meant  the  hollow  of  the  skull), 
are  fallacies  that  depend  upon  the  individuality  of  the  particu- 
lar man.  Apparently,  for  his  namesake  and  predecessor, 
everybody  in  general  is  more  or  less  subject  to  identical  stum- 
bling-blocks. For  Francis  Bacon  the  individualities  of  men 
stood  out.  Under  this  head  the  Baconian  practical  rule  for 
avoiding  individual  tendencies  to  error  runs  as  follows :  "Let 
every  student  of  nature  in  general  take  this  as  a  rule,  that 
whatever  his  mind  seizes,  dwells  upon  with  particular  satis- 
faction, is  to  be  held  in  suspicion."  Whereas  Roger  Bacon 
sees  ignorant  men,  trust  in  inadequate  authority  exerted  from 
without,  Francis  Bacon  sees  clearly  the  error  of  trusting  over- 
much one's  own  internal  authority  based  upon  his  mental  or 
bodily  construction.  The  psychopathic  personalities  that  ap- 
pear so  frequently  in  this  volume  are  pronounced  instances  of 
subjection  to  the  Idola  Speciis,  or  idols  of  the  cave,  of  Francis 


THE    KINGDOM    OF    EVILS  421 

Bacon.  Of  course  we  suspect  that  these  "Idols  of  the  Hollow 
of  the  Skull"  are  somewhere  dependent  upon  peculiarities  of 
the  brains  contained  within  the  skull  or  upon  peculiar  influ- 
ences streaming  in  upon  those  brains  from  the  rest  of  the 
body.  It  is  clear  that  the  classification  formulated  for  the 
Idols  of  one's  brain  pan  must  be  our  familiar  war  cry  in  all 
forms  of  mental  hygiene — "individualization."  If  we  are  to 
adjust  inner  relations  to  outer  relations,  as  Spencer  contends, 
for  a  perfect  life,  we  shall  be  compelled  to  hold  sharply  to  it 
when  the  inner  relations  themselves  are  defective.  What  a 
rigid  aspect  the  notion  of  "cure"  takes  on  when  by  "cure" 
we  compromise  all  the  individualizing  processes  of  adjustment 
entailed  by  the  individual  peculiarity  of  man ! 

The  third  class  of  Idola  were  the  Idola  Fori,  or  Idols  of 
the  Market  Place.  These  errors  or  fallacies  Francis  Bacon 
contended  arose  from  the  influence  exerted  upon  the  mind  by 
mere  words.  This  class  of  Idola  corresponds  somewhat  to 
Roger  Bacon's  stumbling-blocks  of  the  parading  of  superficial 
wisdom.  How  many  empty  formulae  exist  in  social  work, 
not  to  say  also  in  the  work  of  physicians  and  of  public  serv- 
ants, that  ought  to  be  classed  in  the  Baconian  Idola  Fori ! 
Book  II  presented  at  length  cases  that  illustrate  a  variety  of 
formulae  of  social  difficulties  in  a  series  of  cases.  The  cases 
run,  for  example,  all  the  way  from  that  of  Rose  Talbot  (case 
8),  in  which  all  five  forms  of  social  difficulty  were  presented 
to  the  five  instances  (cases  34  to  38)  in  which  one  class  only 
of  social  difficulty  were  found.  Now  in  point  of  actual  prac- 
tice the  social  worker  is  altogether  too  much  inclined  to  classify 
a  given  case  as  one  of  disease  alone,  or  of  ignorance  alone  (or 
other  form  of  error),  of  legal  entanglement,  or  of  poverty 
alone.  This  tendency  may  simplify  the  keeping  of  social 
record  books  but  it  does  not  comport  with  the  actual  situation 
in  point  of  social  fact.  It  is  a  tendency  that  belongs  with  the 
Idola  Fori,  or  Idols  of  the  Market  Place,  in  the  Baconian  sense, 
to  fall  under  the  spell  of  this  particular  error, — to  classify 
under  but  one  head.  How  simple  social  work  would  be  if 
cases  all  fell  smoothly  into  place  as  cases  to  cure  merely,  merely 
to  reeducate,  or  again  merely  to  reform,  to  supply  with  legal 
aid,  or  to  compensate  in  any  monetary  sense ! 

Let  us  call  especial  attention  at  this  point  also  to  that  group 
of  cases  in  Book  II  which  exhibits  simple  binary  combinations 


422  THE    KINGDOM    OF    EVILS 

of  two  forms  of  social  difficulty.  If  we  should  consider  the 
simplest  case  of  medical  social  work — namely,  a  case  which 
showed  but  two  factors  say,  (i)  need  of  orthopedic  splint, 
(2)  need  of  money — possibly  these  two  needs  could  be  sepa- 
rately met.  Possibly  the  granting  of  financial  relief  would 
forthwith  settle  the  question  of  getting  a  splint.  In  such  an 
instance  the  primary  social  difficulty  might  well  turn  out  to  be 
poverty.  Whilst  the  orthopedic  need  might  be  a  very  remote 
and  secondary  phenomenon.  But  suppose  we  have  a  combina- 
tion of  poverty  with  such  a  weak  will  disorder  as  lack  of  ambi- 
tion. Let  us  suppose  this  lack  of  ambition  is  not  psychopathic. 
Then  it  is  obvious  with  half  an  eye  that  the  dole-giving  is  not 
going  to  settle  the  problem.  Yet  to  quote  Richmond's  "Social 
Diagnosis,"  there  was  in  charity  organization  work  "at  first 
no  accepted  program  of  treatment  other  than  the  giving  or 
withholding  of  relief."  Here  and  there  advanced  agencies 
formed  more  thorough  programs  of  what  could  be  done;  but 
in  the  earlier  days  these  were  carried  out  with  difficulty  against 
the  main  current  of  charity  activity  which  ran  strongly  toward 
dole-giving.  These  two  instances  may  suffice  to  raise  the  im- 
portant point  that  we  shall  learn  more  and  more  about  social 
work  if  we  study  merely  binary  combinations  of  social  diffi- 
culty. That  is  the  combinations  of  Morbus  with  Error  or 
Morbus  with  Vitiuin,  or  Morbus  with  Litigium,  or  Morbus 
with  Penuria,  or  Error  with  Pcmiria,  or  Vitium  with  Litigium, 
Vitium  with  Penuria,  Litigium  with  Penuria-.  The  cases  of 
binary  combination  (cases  24  to  33  inclusive)  in  Book  II  of 
course  present  only  a  simple  indication  of  the  possibilities  of 
each  of  the  five  main  groups.  A  vast  deal  of  work  must  be 
done  when  we  get  into  the  main  outlines  of  social  work  en- 
tailed by  a  study  of  binary  combinations.  When  two  social 
difficulties  are  loosely  associated  with  one  another,  so  that  each 
may  be  simply  and  separately  treated,  social  work  will  be  rela- 
tively easy.  But  when  two  difficulties  are  multiplied  into  one 
another  social  work  will  be  relatively  hard. 

To  continue  with  our  remarks  upon  the  four  classes  of 
Idola,  according  to  Francis  Bacon  we  find  the  fourth  and  last 
class  to  be  the  Idola  Tlieatri,  or  so-called  Idols  of  the  Theater. 
(The  theater  here  means  the  speculative  or  "theorizing"  mind 
and  does  not  refer  to  theater  in  the  ordinary  sense.)  The 
victims  of  this  class  of  Idola  are  those  who  force  nature  into 


THE    KINGDOM    OF    EVILS  423 

empty,  abstract  schemes  and  want  to  explain  existing  condi- 
tions by  mere  definition.  Again  there  are  those  that  leap  to 
general  conclusions  by  too  few  experiments,  or  again  those  that 
work  in  an  imaginative  way  by  the  overuse  of  analogies.  This 
particular  type  of  error  is  one  which  the  theorists  of  social 
work  must  take  to  heart.  The  existence  of  these  Idola  of  the 
speculative  mind  is  the  best  reason  for  our  having  chosen  to 
place  the  case  material  of  this  volume  at  the  outset  rather  than 
as  merely  illustrative  material.  We  have  tried  to  analyze  some 
of  the  cases  available  to  us,  with  the  richest  display  of  facts 
and  most  intensive  social  treatment,  and  to  deduce  from  these 
data  certain  general  principles.  If  the  reader  dissents  from 
the  principles  he  has  the  recourse  of  going  back  to  the  facts. 
Moreover,  as  the  cases  are  for  the  most  part  still  alive  and 
both  capable  of  investigation  and  willing  to  tell  their  stories, 
we  shall  in  the  long  run  be  able  to  test  the  validity  of  our  own 
conclusions  by  the  test  of  time. 

THE    PROBLEM    OF    EVIL 

Although  we  have  drawn  the  analysis  of  this  volume  upon 
a  classification  of  the  social  evils  taken  in  their  broadest  sense, 
we  cannot  pretend  to  be  competent  in  the  theory  of  morals  or 
to  write  a  textbook  of  ethics.  No  doubt  the  historical  de- 
velopment of  the  idea  of  medical  social  work  (and  naturally 
of  its  related  branch  psychiatric  social  work)  are,  in  the  New 
England  community  in  which  we  write,  greatly  influenced  by 
the  philosophical  work  of  Professor  Josiah  Royce  upon  the 
problem  of  evil.  Professor  Royce's  work  upon  evil  as  well 
as  upon  social  consciousness  and  later  upon  the  logical  theories 
of  order  have  unquestionably  prescribed  some  of  the  most  im- 
portant lines  in  Dr.  Richard  C.  Cabot's  development  of  medical 
social  work  and  in  our  own  additions  to  the  concept  from  the 
field  of  mental  hygiene.  We  have  been  compelled  to  choose 
mottoes  for  the  four  books  from  Job.  The  initial  paper  in 
Professor  Royce's  Studies  of  Good  and  Evil  deals  with  the 
problem  of  Job.  The  problem  of  Job,  according  to  Royce,  is 
the  problem  of  unearned  ill  fortune.  Whatever  evil  is,  Royce 
is  most  cordially  of  the  opinion  that  it  is  a  "distinctly  real  fact, 
a  fact  just  as  real  as  the  most  helpless  and  hopeless  sufferer 
finds  it  to  be  when  he  is  in  pain."     Elsewhere  he  speaks  of 


.424  THE    KINGDOM    OF    EVILS 

another  view,  "that  essentially  pernicious  view  nowadays  some- 
what current  amongst  a  certain  class  of  gentle  but  inconsequent 
people — the  view  that  all  evil  is  merely  an  illusion  and  that 
there  is  no  such  thing  in  God's  world."  Good  and  evil,  ac- 
cording to  Royce,  do  not  exist  as  opponents  but  merely  as  ex- 
clusive agents  side  by  side  in  experience.  A  longer  account 
of  this  view  runs  as  follows  : — 

"Taking  a  wider  view,  one  may  observe  that  the  greater  part 
of  the  freest  products  of  the  activity  of  civilization  in  cere- 
monies, in  formalities,  in  the  long  social  drama  of  flight,  of 
pursuit,  of  repartee,  of  contest  and  of  courtesy,  involve  an 
elaborate  and  systematic  delaying  and  hindering  of  elemental 
human  desires,  which  we  continually  outwit,  postpone,  and 
thwart,  even  while  we  nourish  them.  When  students  of  human 
nature  assert  that  hunger  and  love  rule  the  social  world,  they 
recognize  that  the  elemental  in  human  nature  is  trained  by 
civilization  into  the  service  of  the  highest  demands  of  the 
Spirit." 

A  briefer  formula  is  as  follows : — 

"It  is  impossible  for  one  to  know  a  higher  good  than  comes 
from  the  subordination  of  evil  to  good  in  a  total  experience. 
Love  of  moral  good  is  the  thwarting  of  lower  loves  for  the 
sake  of  higher  organization." 

It  will  be  seen  that,  according  to  Royce,  "the  eternal  world 
contains  Gethsemane." 

This  point  of  view  ot  Royce's  is  the  point  of  view  of  the 
so-called  philosophical  idealism  ("your  sufferings  are  God's 
sufferings").  It  is  obvious  that  the  considerations  of  the  pres- 
ent volume  do  not  depend  in  the  slightest  upon  any  philosoph- 
ical view  whatever.  Even  if  we  should  run  with  the  "essen- 
tially pernicious  view"  which  regards  all  evil  as  an  illusion,  we 
should  nevertheless  have  to  grant  the  existence  of  the  illusion 
as  a  distinctly  real  fact.  The  illusions  and  delusions  of  the 
sane  we  should  be  inclined  to  place  in  our  group  of  Errores. 
We  should  regard  those  who  identify  diseases,  sins,  crimes,  re- 
sourcelessness  with  the  delusions  as  unwise  persons  who  have 
made  singularly  poor  use  of  some  of  the  formulae  of  philo- 
sophical idealism. 

In  the  course  of  writing  this  volume  we  have  met  sundry 
persons  who  have  denied  the  existence  of  evil  under  that  name, 
maintaining  that  evil  is  an   illusion  or  an  error.     We  have 


THE    KINGDOM    OF    EVILS  425 

wondered  whether  they  were  not  all  unconsciously  identifying 
the  genus  with  the  species  and  abolishing  the  regmini  malorum 
with  its  subgroup  Err  ores.  We  are  the  more  inclined  to  draw 
this  conclusion  from  our  observation  that  these  verbal  de- 
stroyers of  evil  are  ordinarily  turned  to  the  hypothesis  that 
the  illusions  and  errors,  or  surrogates  of  evil,  are  to  be  de- 
stroyed by  "taking  thought,"  by  adopting  certain  beliefs  and 
sometimes  by  the  plain  anodyne  of  forgetting.  Even  the  so- 
called  Christian  Science  may  fall  back  upon  establishing  sana- 
toria, thereby  conceding  that  there  is  a  special  form  of  error 
needing  hospital  treatment.  Christian  Scientists  also  would 
be  righteously  incensed  if  their  opponents  should  charge  them 
with  not  encouraging  morality  or  the  legal  order.  If  the  repre- 
sentatives of  sundry  movements  for  faith  cure  have  been 
charged  with  a  loss  of  interest  in  the  problems  of  poor  relief 
and  charity  in  certain  communities,  in  any  event  the  believers 
in  these  cults  are  for  the  most  part  kindly  persons  as  interested 
in  the  economic  successes  of  the  community  as  their  fellow 
beings.  Accordingly,  we  repeat,  the  point  of  view  of  the  pres- 
ent work  does  not,  strictly  speaking,  need  to  take  account  of 
any  philosophical  view  of  evil,  even  such  a  view  as  that  of 
Christian  Science,  which  turns  even  disease  into  a  form  of 
error.  Perhaps,  we  should  concede  that  the  point  of  view  of 
the  ingrained  pessimist  cannot  be  the  point  of  view  of  social 
work.  The  point  of  view  of  Voltaire  or  Nietzsche  is  not  the 
point  of  view  of  the  social  worker,  although  be  it  remembered 
to  the  credit  of  Voltaire  that  he  leaves  his  wretched  heroes  and 
heroines  at  the  end  of  Candide  working  in  a  garden,  and  even 
Nietzsche  insisted  that  the  strong  were  strengthened  by  evil. 

There  can  be  no  doubt  that  the  practical  social  worker  needs 
to  have  some  philosophical  and  religious  views  of  the  nature 
of  good  and  evil,  not  alone  for  the  social  worker's  own  per- 
sonal guidance  but  for  the  sake  of  grasping  ingenious  argu- 
ments which  sundry  depressed,  deluded  patients  are  prone  to 
offer.  According  to  Royce,  the  first  hypothesis  concerning 
evil  is  that  it  is  nothing  but  natural  phenomena — "dirt  of  the 
natural  order,  whose  value  is,  that  when  you  wash  it  off  you 
learn  the  charm  of  the  bath  of  evolution."  The  second  hy- 
pothesis is  that  evil  has  a  medicinal  and  disciplinary  value. 
The  third  hypothesis  runs  to  the  effect  that  all  real  evils  are  the 
results  of  free  finite  moral  agents.     And  finally,  according  to. 


426  THE    KINGDOM    OF    EVILS 

Royce,  the  fourth  hypothesis  of  philosophical  idealism  runs 
to  the  effect  that  the  entire  world  is  built  on  a  basis  of  "inner 
tension  of  manifold  impulses  and  interests,"  which,  as  he  re- 
marks, are  not  "mere  accidents  of  rather  imperfect  human 
nature  but  must  be  a  type  of  the  organization  of  every  rational 
life." 

Our  own  study  has  dealt  not  so  much  with  the  definition  of 
evil  as  with  the  classification  of  the  evils  as  they  have  presented 
themselves  in  the  Psychopathic  Hospital,  a  clearing-house  for 
the  evils  of  individual  man.  Our  study  has  been  an  inductive 
one  from  the  concrete  facts  to  a  classification  of  these  facts  in 
certain  groups.  These  groups,  it  appeared  to  us,  might  effec- 
tively be  united  in  a  greater  group  of  evils  taken  in  a  more 
general  way.  We  have  thus  come  upon  an  idea  of  the  social 
worker  as  a  person  professionally  at  work  amongst  all  types 
of  evil.  The  social  worker,  as  we  remarked  above,  must  re- 
main a  layman  with  regard  to  the  great  special  fields  of  medi- 
cine, education,  morals,  jurisprudence,  and  economics.  But 
the  social  worker  is  a  very  intensive  sort  of  layman  with,  some 
might  say,  an  exaggerated  amount  of  common  sense — that 
kind  of  comprehensive  insight  which  utilizes  the  professional 
specialist  without  supplanting  him. 

The  Roycean  formula  of  the  inner  tension  of  manifold  im- 
pulses and  interests  within  our  natures  goes  a  step  further 
than  the  Spencerian  formula  of  the  adjustment  of  inner  to 
outer  relations.  In  the  first  place  Royce  calls  attention  to  the 
existence  of  tensions  within  our  own  make-ups,  and  in  the 
second  place  he  seems  to  define  ethics  in  terms  of  the  relations 
of  the  interior  tensions.  We  have  had  abundant  cause  to  ob- 
serve a  practical  truth  in  our  patients  of  this  hypothesis  of 
interior  tensions.  But  the  world's  evil,  even  according  to 
Royce,  is  not  confined  to  the  inner  life  of  a  man  but  has  spread 
through  the  universe.  Certainly  in  that  part  of  the  universe 
with  which  we  are  dealing ;  namely,  society,  some  sort  of  ten- 
sions have  been  found  to  prevail.  But  can  we  conceive  that 
the  analyses  of  the  present  work  do  not  hang  upon  the  com- 
parative richness  of  the  Spencerian  or  the  Roycean  formulae 
concerning  relations  in  the  universe  ?  The  cases  here  presented 
are  presented  on  a  practical  level  and  the  workers  who  worked 
with  them  have  as  a  rule  paid  no  heed  to  philosophical 
questions. 


THE    KINGDOM    OF    EVILS  427 

But  the  social  worker  must  not  think  that  because  she  is 
practical  she  is  inevitably  just  like  everybody  else  in  her  point 
of  view  toward  the  world.  It  would  seem  that  the  social 
worker  possesses  a  special  temperament.  At  least  the  medical 
and  psychiatric  social  workers  have  a  greater  interest  pri- 
marily in  the  destruction  of  evil  than  in  the  construction  of 
good.  When  such  workers  rationalize  their  attitudes  they  say 
to  themselves  that  by  destroying  evils  they  are  helping  to 
create,  or  allowing  to  be  distributed,  goods,  but  the  tempera- 
ment which  sees  evil  as  the  proximate  task  of  destruction  and 
good  as  the  ultimate  goal  is  nevertheless  a  temperament.  And 
it  is  a  temperament  that  not  everybody  possesses.  It  would 
seem  that  there  are  dragon-slayers  and  Grail-hunters.  There 
are  those  who  prefer  to  be  St.  George  and  others  who  would 
rather  be  Sir  Galahad. 

It  is  doubtful  whether  the  decision  to  be  one  or  the  other  is 
always  a  conscious  or  rational  one.  Those  of  us  who  are 
informed  of  the  spirit  of  medicine  or  medical  and  psychiatric 
social  work,  or  of  nursing,  or  of  the  probation  officer  and  the 
like,  are  wakened  up  in  astonishment  to  the  fact  that  there  are 
perfectly  good  citizens  in  the  world  who  prefer  to  put  diseases 
and  other  forms  of  evil  entirely  out  of  mind.  Nor  can  we 
set  down  these  persons  who  are  not  interested  in  evil  as  merely 
materialistic.  Often  they  prove  perfectly  admirable  seekers 
after  a  Grail  of  one  kind  or  other.  The  devotees  of  religion, 
wizards  of  scientific  invention,  and  the  artists,  do  not  have, 
as  a  rule,  any  interests  that  might  be  termed  malecidal:  they 
are  not  built  for  the  destruction  of  evil,  nor  should  we  wish 
to  swerve  these  zealots  of  the  Grail  from  their  goal.  In  fact 
the  Grail-hunting  temperament  in  its  highest  development  is 
next  to  impossible  to  divert.  We  had  best  not  waste  our  time 
and  theirs  by  offering  wares  of  social  work  to  the  inborn  Grail- 
seekers.  But  there  remains  a  great  mass  of  people  whose 
parental  and  filial,  and  especially  whose  maternal,  joys  give 
them  the  fundaments  of  social  interest.  From  amongst  the 
common  people  we  shall  draw  many  of  our  best  workers  if  we 
can  interest  them  in  the  social  task,  and  if  we  can  believe  that 
through  evolution  habits  of  destruction  are  deeply  imbedded 
in  all  of  us.  Let  us  point  these  destructive  powers  in  the  di- 
rection of  evil.  That  is  the  essence  of  strategy  underlying 
this  particular  kind  of  social  work.     In  our  task  of  persuading 


428  THE    KINGDOM    OF    EVILS 

the  everyday  citizen  that  his  proximate  task  is  to  destroy  evil 
we  have  a  number  of  points  in  our  favor.  If  he  repHes  that 
he  would  rather  do  good  than  merely  undo  evil  we  can  reply 
to  him  "What  after  all  is  the  good  which  you  would  like  to 
do?"  The  chances  are  that  his  first  response  would  have  to 
do  with  getting  rid  of  some  near-by  evil.  We  can  point  out 
to  him  that  evil  is  very  easy  to  perceive  about  us.  Evil  is 
easier  to  perceive  than  good  is  even  to  conceive.  Percep- 
tion was  ever  easier  than  conception.  We  see  evil  all  about 
us.  We  do  not  need  to  make  elaborate  conceptions  or  inter- 
pretations of  the  evil  that  is  at  hand.  Again,  evil  is  not  only 
easier  to  perceive  than  good  to  conceive  but  evil  subdivides 
very  readily  into  plurality  of  evils.  The  good  is  rather  apt 
to  remain  a  unit  or  to  subdivide  itself  far  less  readily.  The 
farmer  has  sick  cattle.  It  is  plain  that  they  must  be  cured  or 
for  their  own  comfort  be  killed.  But  suppose  the  farmer  tries 
a  program  of  construction.  Shall  he  breed  for  beef  or  for 
milk?  The  plot  thickens  at  once.  If  we  look  into  the  vocabu- 
lary for  words  descriptive  of  good  and  evil  respectively,  we 
are  certain  to  find  in  most  languages  a  far  larger  number  of 
words  dealing  with  evils  than  with  the  goods. 

Evils  can  thus  be  seen  about  us  (and  be  items  for  destruc- 
tion) far  more  readily  than  the  goods.  It  is  obvious  too  that 
evil  gets  more  clearly  into  the  mind  than  does  good.  For 
whatever  evolutionary  reason  this  is  so  we  do  not  delay  to  dis- 
cuss, but  there  is  something  insictent,  pricking,  sensationally 
painful  about  evils.  They  attract  our  attention  more  readily 
and  are  on  the  whole  more  definable  than  goods.  Finally,  as 
above  insisted,  concerning  our  relative  powers  of  destruction 
and  construction,  we  men  are  built  more  for  destruction  than 
for  construction,  or  at  all  events  are  more  used  to  the  destruc- 
tive processes  in  our  daily  lives.  We  should,  therefore,  take 
advantage  of  this  ingrained  destructive  trend  and  endeavor  in 
the  first  instance  to  destroy  definite  concrete,  and  observable 
evils  rather  than  try  to  construct  indefinite,  abstract,  hardly 
conceivable  good.  Let  the  proximate  task  of  evil  destruction 
be  accomplished  and  the  ultimate  task  of  constructive  good- 
ness will  shortly  follow.  The  formula  might  run  "Get  the 
Grail  but  first  slay  the  dragon."  These  are  perhaps  the 
main  arguments  to  the  hypothesis  of  evil's  primacy  in  the 
realm  of  social  tasks.     We  are  entirely  certain  that  various 


THE    KINGDOM    OF   EVILS  429 

readers  of  the  Grail-hunting  group  will  persist  in  misunder- 
standing our  program.  They  will  not  distinguish  a  technique 
that  deals  with  proximates  from  a  program  that  runs  towards 
ultimates.  We  conceive  that  social  work  is  a  kind  of  human 
technique  of  proximate  nature  whose  lines  are  laid  down  in 
the  interest  of  ultimate  good. 

We  have  been  bold  enough  to  borrow  mottoes  from  the  book 
of  Job.  We  have  taken  care  to  take  them  from  the  words  of 
Job  himself  rather  than  from  the  words  of  his  friends.  These 
friends,  however,  skillful  in  rhetoric,  would  perhaps  not  prove 
the  most  successful  of  social  adjusters.  Without  undertaking 
elaborate  analysis  of  the  endeavors  of  Job's  friends,  for  which 
we  are  entirely  incompetent,  we  are  nevertheless  inclined  to 
assert  that  the  world  has  made  a  considerable  advance  upon 
the  ethical  situation  depicted  in  Job.  Job  said  that  his  error 
remained  with  himself,  that  when  he  cried  out  of  wrong  he 
was  not  heard,  that  there  was  no  justice,  and  that  the  hand  of 
God  had  touched  him.  He  thus  made  an  almost  complete 
analysis  of  his  plight,  finding  concrete  evils  in  most  of  the 
departments  we  have  discussed.  Is  it  too  much  to  say  that 
the  spirit  of  civilization,  the  spirit  of  Christianity  if  you  will, 
has  shifted  the  universe  of  evil  at  least  by  a  few  units?  That 
the  land  of  the  shadow  of  death  could  contain  any  sort  of 
order  hardly  entered  Job's  mind.  It  was  to  him  the  highest 
of  rhetorical  flights  to  think  of  the  weighing  of  his  calamities. 
In  all  these  respects  the  modern  world  has  gained  a  plan  of 
attack  which  Job's  world  certainly  possessed  not. 

Finally  as  to  the  motto  with  which  we  have  introduced 
Book  IV,  the  nineteenth  century  by  its  researches  has  served 
to  magnify  the  interest  of  man,  if  not  yet  to  offer  a  perfect 
technique  for  preserving  him.  Remarks  like  these  are  petty 
enough  beside  the  terror  of  the  facts.  We  do  not  find  the 
social  worker  irreligious;  but  if  the  social  worker  were  at  the 
outset  irreligious,  she  speedily  comes  to  a  sufficient  solemnity 
— the  solemnity  of  the  interrelations  of  the  deeper  things  in 
mind  and  morals. 

Thus  we  conclude  certain  generalities  about  the  evils.  By 
the  very  order  of  presentation  of  the  material  in  this  work  we 
have  intended  to  show  that  our  work  ran  from  observed  de- 
tails upward  to  more  or  less  tentative  general  statements,  and 
not  at  all  from  any  preconceived  principles  downward  to  the 


430 


THE    KINGDOM    OF    EVILS 


facts.  Our  study,  as  we  have  repeatedly  maintained,  is  induc- 
tive and  not  deductive.  In  point  of  fact  the  observations  made 
were  made  in  the  first  instance  without  any  grouping  of  the 
evils  and  the  maladjustments  whatever.  It  was  only  when  we 
came  to  put  our  work  together  that  we  found  our  material 
grouping  itself  in  the  way  most  elaborately  presented  in  Book 
II  of  this  work.  We  think  some  such  classification  presented 
in  some  order  on  the  principles  of  this  work  will  maintain 
itself  in  future  social  work;  but  whether  it  does  or  not,  the 
materials  for  this  particular  analysis  were  not  collected  with 
these  categories  in  mind,  but  were  collected  with  the  general 
principles  of  psychiatric  social  investigation  in  mind. 

APPLICATIONS    OF     THE    FIVEFOLD     CLASSIFICATION     OF    EVILS 
OUTSIDE   THE    FIELD    OF    SOCIAL   WORK 

Our  fivefold  classification  of  evils,  to  which  Book  II  is 
largely  devoted,  is  a  classification  that  might  be  applied  with 
great  generality  to  vast  areas  of  phenomena  outside  the  field 
of  social  case  work.  It  is  beyond  the  province  of  this  volume 
to  discuss  these  wider  applications,  though  the  entire  social 
problem  would  plainly  profit  thereby.  We  shall  confine  our- 
selves to  two  instances  of  the  possible  application  of  our 
method  of  orderly  approach  to  the  classification  of  difficulties 
of  whatever  sort.  Let  these  two  instances  be  the  Great  War 
and  bolshevism. 

Is  war  in  itself  an  evil?  The  Crusaders  and  the  American 
Revolutionists  might  well  resent  the  charge  so  far  as  it  con- 
cerned their  own  aims  and  duties.  Yet  they  would  be  com- 
pelled to  grant  the  unfolding  of  numerous  evils  in  the  train  of 
crusades  or  revolutions.  To  our  minds  the  assertion  that  war 
is  an  ez'il  is  logically  far  less  accurate  a  statement  than  that 
war  entails  ez'ils.  War  entails  a  plurality  of  evils.  What, 
now,  are  these  evils  ?  We  think  they  can  readily  be  distributed 
amongst  our  five  groups,  though  some  might  desire  that  we 
add  a  sixth  miscellaneous  group  for  troubles  not  specifically 
listed  as  disease,  error,  vice,  legal  difficulty,  and  poverty.  In 
the  wake  of  war  comes  disease  and  pestilence.  Educational 
systems  crumble  in  war  time,  vicious  attitudes  abound.  The 
legal  order  is  assailed.     Poverty  reigns. 

If  every  analyst  of  reconstruction  were  to  catalogue  the 


THE    KINGDOM    OF    EVILS  43I 

evils  of  war  even  in  this  rough  manner,  he  would  greatly 
assist  in  the  definition  of  every  post  bellum  task.  Re- 
formers with  but  a  single  nostrum  would  have  no  preferred 
standing  in  political  councils,  whether  amongst  government 
officials  or  amongst  the  voluntary  associations  of  the  com- 
munity. An  eventual  combined  development  of  health  pro- 
grams with  educational  programs  would  be  assured.  The 
representatives  of  the  church,  the  lecture  platform,  and  the 
theater,  as  shapers  for  better  or  worse  of  community  morals, 
would  find  themselves  shoulder  to  shoulder  with  the  representa- 
tives of  government  and  law.  In  particular,  nobody  with  an 
economic  panacea  would  be  allowed  to  run  wild  without  com- 
petition amongst  theories  of  reconstruction.  To  split  evil  into 
such  great  rough  groups  as  our  chosen  five  of  evils  would 
represent  an  advance  in  social  reconstruction  hardly  to  be  hoped 
for  in  an  era  of  single-track  minds.  Yet  there  would  be  a 
place  in  the  sun,  a  true  locus  for  the  single-track  minds  in  the 
pragmatic  attack  upon  each  of  the  evils  taken  separately  and 
distributively  by  some  single  specialist — a  specialist,  as  you 
might  say,  in  the  slaying  of  a  particular  variety  of  dragon.  The 
higher  speed  and  the  greater  safety  can  no  doubt  be  attained 
upon  the  single,  switchless  track,  and  the  straighter  the  better. 
In  short,  the  trouble  is  the  ancient  trouble  of  the  many  and 
the  one,  that  is,  the  determining,  amongst  a  plurality  of  things 
to  do,  the  pragmatic  unit,  the  thing  that  "makes  a  difference." 

We  may  again  insist,  as  particularly  pertinent  to  these  gen- 
eralized applications  of  our  method  of  orderly  approach,  that 
the  items  in  the  list  and  the  order  to  be  adopted  in  their 
consideration. are  of  lesser  consequence  than  the  adoption 
of  some  order  in  the  consideration  of  chosen  categories. 
Suppose  now,  that  we  were  to  analyze'phenomena  of  the  Great 
War,  no  longer  from  the  standpoint  of  the  immediate  task  of 
reconstruction  but  rather  from  the  standpoint  of  historical 
analysis  to  the  end  of  the  prevention  of  future  wars.  We 
should  be  looking  into  causes.  Here  again  the  method  of 
orderly  approach  in  the  analysis  of  data  has  value. 

Was  there  a  morbid  factor  at  the  bottom  of  the  Great 
War  or,  more  moderately  speaking,  were  morbid  factors  at 
all  seriously  in  evidence?  Of  course  some  German  propa- 
gandists went  so  far  as  to  describe  the  French  attitude  at  the 
outset  of  the  Great  War,  and  at  various  times  when  the  French 


432  THE    KINGDOM    OF   EVILS 

refused  to  treat  for  peace,  as  an  example  of  Psycho pathia 
Gallica.  This  Psychopathia  Gallica  was  a  national  revenge- 
psychosis!  One  German  disputant  objected.  He  noted  a  re- 
sponsibihty  on  the  part  of  the  Germans  to  France  if  France 
was  a  national  victim  of  mental  disease:  France  would  then 
have  to  be  pitied !  But,  seriously  speaking,  was  there,  or  was 
there  not,  a  morbid  and  especially  a  psychopathic  factor  in  the 
Great  War?  Was  the  Kaiser  a  psychopath?  The  lay  reader 
must  take  note  that  psychopath  means,  as  elsewhere  in  this 
book,  not  necessarily  an  insane  person  in  the  medico-legal  sense 
of  that  term.  The  Kaiser  might  be  a  psychopath  and,  as 
French  writers  have  for  years  insisted,  have  still  a  degree  of 
responsibility. 

But  we  are  not  here  inquiring  about  the  degree  of  personal 
responsibility  which  might  be  laid  at  the  door  of  a  psycho- 
pathic or  non-psychopathic  Kaiser.  We  are  inquiring  into 
the  causes  of  the  Great  War.  It  would  be  a  nice  question  to 
determine  whether  the  Hohenzollerns  are  in  so  far  eccentric 
or  "off-center"  or  "deviate"  that  they  have  had  an  essential 
share  in  shaping  European  destinies.  There  are  two  views 
about  all  such  matters  which  frequently  blanket  or  forestall 
concrete  investigations.  There  are  those  who  believe  in  some 
variant  of  the  Great-Man  theory  of  history.  There  are  others 
who  are  equally  certain  that  all  big  social  movements  are  mass 
movements,  reminding  one  of  the  prodigies  of  the  social  life 
of  ants,  bees,  and  wasps.  It  is  a  question  whether  the  real 
facts  concerning  the  Hohenzollerns  and  in  particular  concern- 
ing the  now  living  representatives  of  this  group  will  ever  be 
examined  by  psychiatric  experts.  Great  educators,  wise  philos- 
ophers, exalted  preachers,  profound  moralists,  learned  judges, 
ingenious  advocates,  formulating  political  economists  and 
sociologists,  to  say  nothing  of  estimable  laymen,  will  claim 
the  right  to  make  this  momentous  decision.  Many  decades  will 
go  by,  possibly  a  century  or  more,  before  we  can  replace  the 
current  interpretations  of  history  with  a  psychiatric  interpreta- 
tion. Yet  until  that  psychiatric  interpretation  comes  we  shall 
not  have  tried  out  one  of  the  likeliest  measures  of  prevention. 
Who  now  knows  whether  both  the  origin  of  tyranny  and 
tyranny's  fate  were  not  matters  of  psychopathic  interest? 

But  now  let  us  suppose  either  that  there  were  no  morbid 
factors  or  only  partially  effective  morbid  factors  in  the  Great 


THE    KINGDOM    OF    EVILS  433 

War,  shall  we  not  assign  the  Great  War's  origin  to  our 
group  of  Errores?  Was  not  Darwinism  misinterpreted  by 
German  expounders?  Was  not  the  German  populace  misin- 
formed concerning  political  causes  and  effects?  Did  the  Ger- 
mans not  proceed  upon  an  erroneous  theory  of  morals  incul- 
cated under  the  influence  of  the  Hohenzollerns,  Bismarck, 
Treitschke,  and  Nietzsche?  Here  is  a  very  pretty  inquiry, 
localized  in  the  field  of  popular  education  and  the  general  opin- 
ion of  German  society.  Did  not  Willisen  and  Clausewitz  mis- 
interpret the  Napoleonic  successes  and  method  and  supply  the 
German  community  with  nationalistic  ideas  basically  wrong? 
In  this  part  of  our  inquiry  we  should  need  to  abstain  absolutely 
from  any  considerations  of  mental  disease  or  of  false  morals. 
Should  it  be  inquired  whether  perhaps  Nietzsche  was  not  a 
psychopath  and  his  Will  to  Power  the  reflection  of  a  psycho- 
pathic pessimism,  then  our  inquiry  would  run  back  to  the  group 
of  Morbi.  Should  we  determine  that  Nietzsche,  like  his 
predecessor  Schopenhauer,  was  importantly  a  psychopath,  then 
our  ideas  concerning  the  origin  of  the  war  would  change  and 
some  of  our  measures  for  prevention  would  take  into  account 
the  necessity  of  analyzing  the  claims  of  a  Schopenhauer  or  of  a 
Nietzsche  long  before  political  economists  usually  think  phi- 
losophy needs  attention.  Yet  the  ideas  of  a  Schopenhauer  and 
of  a  Nietzsche,  let  them  be  as  vitriolic  and  destructive  by 
nature  as  they  list,  would  perhaps  not  be  dangerous  to  society 
if  they  were  not  spread  by  an  educational  process,  either  by 
chance  or  by  design. 

If  it  should  be  discovered  that  leaders  of  German  thought 
for  national  political  purpose  deliberately  encouraged  the 
spread  of  the  psychopathic  ideas  of  a  Nietzsche  or  a 
Schopenhauer,  then  the  inquiry  might  throw  back  once  more 
to  the  question  whether  the  leaders  of  German  thought  were 
themselves  psychopathic  or  whether  they  were  merely  mis- 
taught  by  predecessors  who  were  possibly  psychopathic,  or 
whether  they  were  persons  with  a  vicious  streak.  In  short, 
this  inquiry  concerning  the  spread  of  ideas  ultimately  trace- 
able to  a  psychopathic  origin  might  lead  us  at  the  outset  to 
moral  attitudes  falling  in  our  group  of  the  V'itia;  but,  at  one 
degree  removed  and  in  the  second  generation  of  educators,  we 
might  find  that  the  total  immediate  cause  of  the  German  atti- 
tude towards  world  domination  lay  in  our  second  group  of 


434  '  THE    KINGDOM    OF    EVILS 

Errores.  That  is  to  say,  ideas  might  arise  in  the  group  Morbi 
or  they  might  not,  but  these  ideas  might  be  promulgated  as 
misinterpretation,  or  misinformation  by  the  mistaken  leaders 
of  a  given  generation  (belonging  in  group  E),  themselves  not 
at  all  psychopathic  (i.e.  not  in  group  M)  and  even  not  at  all 
vicious  ( not  in  group  V ) .  They  would  secure  our  forgiveness 
"for  they  know  not  what  they  do."  But  again  there  might  be 
certain  vicious  leaders  of  thought  (group  V)  who  would  in- 
fluence a  circle  of  less  powerful  thinkers  (group  E),  who 
would  spread  ideas  derived  from  the  vicious  politicians,  who,- 
however,  might  have  obtained  their  ideas  from  psychopaths 
(group  M).  The  analysis  might  run  in  a  variety  of  ways; 
but  our  general  thesis  ought,  we  think,  to  be  accepted,  namely, 
that  analysis  under  some  such  groups  or  categories  as  we  have 
here  chosen  would  be  of  the  greatest  advantage  to  the  world. 

It  is  even  possible  that  the  exponents  of  a  peculiar  form 
of  legal  order  might  have  greatly  influenced  the  origins  of 
the  Great  War.  Men  firmly  convinced  of  the  values  of  the 
German  legal  code  might  well  regard  such  code  and  under- 
lying principles  as  the  real  skeleton  and  support  of  world 
civilization.  Jurists  of  this  kidney  would  not  be  psychopaths. 
Their  ideas  would  not  fall  into  the  field  of  education,  as  com- 
monly accepted,  nor  could  we  charge  their  system  with  being 
in  any  obvious  way  a  result  of  misinformation  or  of  misinter- 
pretation. There  is  no  doubt  that  the  representatives  of  medi- 
cine, natural  science,  morals,  religion,  economics,  and  politics 
take  too  little  account  of  juristic  developments.  And  the  jurists 
too  are  doubtless  guilty  of  groping  about  in  the  same  way 
in  their  own  water-tight  compartment.  Only  the  sociologists 
appear  to  try  to  encompass  all  these  points  of  view;  yet,  even 
where  the  sociologists  have  a  wide  range  and  a  sure  touch, 
they  seem  to  us  to  fail  to  take  account  in  an  even  and  repre- 
sentative way  of  all  these  divisions  of  human  interest.  This  is 
particularly  true  of  the  neglect  by  sociologists,  up  to  very  re- 
cent days,  of  any  right  view  of  the  importance  of  the  psycho- 
path in  history. 

Lastly  we  may  consider  that  an  economic  interpretation  of 
history  might  prove  that  the  basis  of  the  Great  War  was 
economic.  Of  course  this  dictum  means  very  little  if  we  are 
listening  to  economists  who  regard  virtually  everything  in  the 


THE    KINGDOM    OF    EVILS  435 

world  as  essentially  economic  in  its  basis.  But  surely  that 
proof  has  never  been  brought. 

Enough  has  been  said  to  intimate  the  sure  advantage  which 
would  follow  analyzing  the  Great  War  in  an  orderly  way  con- 
cerning both  its  origins  and  its  effects.  Advantage  would 
accrue  if  the  phenomena  of  the  Great  War  were  analyzed  under 
the  podtive  categories  of  health,  education,  morals,  law  and 
order,  and  economics.  But  we  contend  that  the  negative  and 
corresponding  categories  of  our  five  groups  would  possess  a 
still  greater  advantage  for  the  analyst. 

Let  us  now  turn  to  bolshevism.  It  would  be  of  funda- 
mental importance  and  value,  could  we  discover  and  disen- 
tangle any  psychopathic  elements  in  bolshevism.  Marx 
was,  no  doubt,  not  at  all  a  psychopath.  Bakunin  on  the  other 
hand  was  no  doubt  a  psychopath.  Socialism  and  anarchism 
need  not  be  set  down  as  non-psychopathic  and  psychopathic  in 
origin  on  account  of  the  nature  of  the  lives  of  their  founders, 
Marx  and  Bakunin.  Modern  anarchists  are  a  little  impatient 
of  any  attribution  of  great  movements  like  socialism  and 
bolshevism  to  great  men  like  Marx  and  Bakunin.  They  are 
prone  to  leap  into  another  category  when  the  argument  waxes 
hot  concerning  individual  founders  and  to  begin  to  talk  about 
general,  economic,  legal,  and  moral  or  educational  tendencies, 
of  mass  movements  and  the  like.  There  is  a  time  for  the  con- 
sideration of  these  other  categories,  but  we  can  see  that  there 
is  a  time  for  rounding  up  all  the  psychopathic  elements  that 
there  may  be.  Let  psychiatric  specialists  deal  to  the  best  of 
their  special  knowledge  and  training  with  these  facts,  and  let 
dll  the  facts  be  considered  that  might  have  a  bearing  on  the 
morbid  sides  of  certain  bolshevistic,  socialistic,  governmental, 
or  capitalist  trends.  (For  in  this  skeleton  of  an  argument  con- 
cerning bolshevism  we  must  not  be  understood  to  say  that  the 
various  proponents  of  law  and  order  and  of  capitalistic  ven- 
tures are  not  also  sometimes  in  an  important  way  psycho- 
pathic.) After  decades  it  may  be  allowable  to  think  of  George 
III  as  a  psychopath.  How  impatient  a  politician  of  the  present 
day  would  be  if  an  inquiry  along  this  line  were  made  concerning 
the  Lenin  who  lives  today !  These  are  very  sharp  tools,  the  ob- 
jector to  our  program  of  the  psychiatric  analysis  of  present- 
day  politics  may  urge.     But  the  tools  we  suggest  are  after  all 


436  THE   KINGDOM    OF    EVILS 

no  sharper  than  the  political  tools  of  terrorism  used  by  a 
Hohenzollern  or  a  Lenin.  Finally  the  world  will  learn  not  to 
flinch  under  the  application  of  expert  analysis. 

But  suppose  we  decide  that  Lenin  and  the  rest  are  not 
psychopathic  or  not  importantly  so,  how  much  of  the  situa- 
tion of  bolshevism  is  an  educational  affair?  How  much  is 
it  due  to  vicious  or  quixotic  moral  attitudes?  How  much  is 
it  due  to  reaction  against  certain  more  or  less  false  ideas  of 
law  and  order  and  how  much,  finally,  is  it  due  to  the  economic 
resourcelessness  of  Russian  peasants?  We  are  not  com- 
petent to  offer  positive  points  concerning  this  analysis,  but  we 
are  inclined  to  think  that  every  dispassionate  person  will  agree 
that  the  present-day  type  of  analysis  of  such  conditions  does 
not  make  for  clarity.  We  can  see  that  it  is  because  the  analyst 
continually  changes  his  categories,  leaping  from  positive  to 
negative  phenomena  and  leaping  from  group  to  group  of  each, 
perhaps  making  each  of  his  arguments  swerve  in  a  particular 
and  favorite  direction. 

The  contentions  in  the  last  few  paragraphs  concerning  the 
possible  analysis  of  the  Great  War  and  of  bolshevism  do  not 
touch  the  argument  concerning  the  utility  of  our  classification 
of  evils  as  applied  to  the  individual  psychopath.  Our  conten- 
tions do  not  rest  upon  a  thorough  study  of  historical  and  po- 
litical phenomena.  We  shall  be  entirely  satisfied  if  the  reader 
regards  these  contentions  as  pure  hypotheses.  The  argument 
will  at  least  serve  to  bring  out  into  stronger  relief  the  method 
of  orderly  approach  in  the  classification  of  social  difficulties 
as  applied  in  the  body  of  our  work. 

THE  METHOD  OF  BOOK  III  :  MAIN  GROUPS  OF   MENTAL  DISEASES 

The  cases  of  Book  III  are  arranged  according  to  their  oc- 
currence in  the  Major  Groups  of  Mental  Disease.  Precisely 
the  same  types  of  patient  are  presented  in  Book  III  as  in  Book 
I,  which  dealt  with  the  spheres  of  influence  and  in  Book  II, 
which  dealt  with  the  various  forms  of  evil.  Our  volume  is 
in  no  sense  a  treatise  on  psychiatry.  Yet  for  several  reasons 
the  arrangement  of  Book  HI  is  a  desirable  one.  In  the  first 
place  physicians,  both  psychiatrists  and  others,  may  want  to 
learn  what  kinds  of  social  work  are  likely  to  be  most  applicable 
in  the  major  groups  of  mental  disease;  and,  whereas  the  m 


THE    KINGDOM    OF    EVILS  437 

count  here  presented  is  far  from  complete,  we  conceive  that 
the  major  issues  of  social  treatment  of  the  mental  diseases  are 
clearly  indicated.  In  the  second  place  the  social  worker  must 
understand  the  larger  features  of  mental  disease  as  shown  in 
the  great  groups  which  physicians  recognize;  even  if  the  social 
worker's  ideas  are  limited  to  very  rough  ideas  concerning  the 
prognosis  in  the  major  groups  of  mental  disease,  she  will  un- 
derstand the  physician's  point  of  view  certainly  better  than  do 
many  teachers,  pastors,  lawyers,  and  business  men,  with  all  of 
whom  the  social  worker  may  have  to  deal.  In  the  third  place 
the  cases  of  Book  III  may  be  used  by  the  reader  for  the  pur- 
pose of  independent  judgment  whether  Book  I's  conclusions 
on  the  spheres  of  influence  and  Book  II's  conclusions  on  the 
forms  of  evil  are  sound  conclusions;  for  the  cases  of  Book  III 
are  presented  in  far  bolder  form  and  with  more  reference  to 
treatment  and  outcome  than  to  the  technique  of  authority 
brought  to  bear  or  of  diagnostic  details. 

What  are  mental  diseases?  Luckily  this  is  not  a  textbook 
of  psychiatry  and  we  are  not  stringently  required  to  ofifer  a 
definition.  For  practical  purposes  the  mental  diseases  are  dis- 
eases which  common  consent  leaves  in  the  hands  of  a  special 
group  of  physicians  for  diagnosis  and  treatment ;  namely,  the 
group  of  so-called  psychiatrists.  Common  consent  means  that 
the  medical  schools,  the  medical  associations,  and  the  medical 
textbooks  are  practically  unanimous  in  conceding  the  existence 
of  a  field  of  mental  diseases,  related  somewhat  closely  with 
the  so-called  nervous  diseases  but  rather  less  closely  with  all 
other  forms  of  disease.  Medical  schools  have  formally  recog- 
nized, though  as  a  rule  very  inadequately,  in  their  curricula 
departments  of  mental  disease  or  of  psychiatry.  National  as- 
sociations, like  the  American  Medico-Psychological  Associa- 
tion, now  the  American  Psychiatric  Association,  exist  for 
the  purpose  of  promoting  the  study  of  mental  diseases  as  op- 
posed to  all  other  forms  of  disease.  Until  recent  years 
these  associations  have  been  far  from  "scientific"  in  the 
sense  of  presenting  programs  of  investigation  and  research. 
Although  the  American  Medico-Psychological  Association  is 
the  oldest  national  medical  association  in  this  country,  yet  its 
progress  upon  lines  of  research  and  investigation  has  up  to 
recent  times  been  singularly  slow.  The  predominance  in  its 
programs  of  administrative  and  other  practical  features  has, 


438  THE    KINGDOM    OF    EVILS 

however,  one  point  to  commend  itself  in  the  eyes  of  the  social 
worker, — the  social  worker  will  find  that  the  practitioner  in 
mental  diseases,  i.e.,  the  psychiatrist,  is  probably  by  nature  and 
training  a  man  especially  accessible  to  ideas  of  social  work. 
In  fact  the  superintendent  of  a  hospital  for  the  insane  and  his 
subordinate  officers  have  often  been  engaged  in  a  type  of  work 
not  far  removed  from  social  work  performed  as  a  rule  inade- 
quately from  a  central  office  desk  and  without  due  emphasis, 
perhaps,  upon  the  educational,  moral,  legal,  and  economic  sides 
of  the  problem.  On  the  whole,  however,  the  psychiatrists  had, 
by  virtue  of  the  very  nature  of  their  material,  made  much 
greater  progress  toward  "socialization"  than  had  practitioners 
in  other  fields  of  medicine.  Many  of  the  underlying  concepts 
of  social  work  are  far  more  deeply  imbedded  in  the  mind  of 
the  psychiatrist  than  in  the  minds  of  other  practitioners  of 
medicine. 

Psychiatry  is  that  field  of  medicine  devoted  to  mental  dis- 
eases, and  psychiatrists  are  the  practitioners  in  that  field. 
Many  readers  are  aware  that  the  term  "psychiatrist"  has  only 
recently  taken  hold  of  this  country.  The  term  "alienist"  is 
still  used  rather  freely  by  the  older  generation.  There  is,  to 
be  sure,  not  much  difference  between  these  terms,  yet  the  slight 
distinction  is  one  which  is  of  the  greatest  importance  to  the 
development  of  mental  hygiene.  The  situation  is  somewhat 
as  follows.  Insanity  and  mental  disease  'are  not  synonymous. 
Insanity  is  a  legal  concept,  mental  disease  is  a  medical  concept. 
A  man  is  sane  or  insane  or  as  yet  indeterminate  as  to  his  in- 
sanity. Many  hold  that  there  are  no  degrees  of  sanity  or 
insanity.  A  multitude  of  courts  will  still  be  found  holding 
that  there  is  but  one  degree  and  but  one  kind  of  sanity  or  of 
insanity. 

On  the  other  hand  there  are  all  degrees  of  mental  health 
and  mental  disease  and  there  are  many  kinds  of  mental  disease. 
Insanity,  we  may  say,  depends  upon  medico-legal  decisions. 
Mental  disease  is  an  affair  of  medicine  alone.  Sanity  and 
mental  health,  decided  respectively  by  the  law  and  by  medi- 
cine, may  characterize  the  same  human  subjects.  But — and 
here  is  the  definite  point — sanity  may  characterise  many  sub- 
jects of  mental  disease.  These  sane  subjects  of  mental  dis- 
ease are  subject  to  mental  disease,  mild  or  severe,  of  a  kind 
or  degree  that  does  not  concern  the  courts.     It  would  even  be 


THE    KINGDOM    OF    EVILS  439 

permissible  to  say  that  no  man  is  either  sane  or  insane  until 
properly  reviewed  and  adjudged  by  the  courts.  It  is  perhaps 
enough  to  claim  that  sanity  and  insanity  are  characteristics 
such  that  courts  decide  them  within  limits  of  accuracy  of 
courts.  Accordingly  sanity  and  insanity  are  legal,  govern- 
mental, public  matters.  On  the  other  hand  mental  health  and 
disease  are  matters  of  individual  medicine  and  individual 
psychology,  and  while  of  familial,  district,  group,  or  com- 
munity interest,  they  do  not  necessarily  even  approach  govern- 
mental regime.  Insanity  is  a  public  matter,  mental  disease  a 
social,  family,  or  personal  matter. 

We  believe  that  the  above  statements  will  be  commonplaces 
in  the  minds  of  many,  perhaps  of  most  advanced  medical  men. 
It  is  probable  that  many  competent  jurists  hold  identical  con- 
cepts. It  was  on  this  basis  that  the  senior  author  of  this  work 
proposed  some  years  since  that  the  medical  specialists,  who 
are  medico-legal  aids,  be  given  the  familiar  and  appropriate 
designation,  alienists,  and  that  the  term  psychiatrists  be  re- 
served for  those  specialists  who  act  as  physicians  only, — in 
short  that  the  insanity  expert  be  spoken  of  as  an  alienist  and 
the  mental-disease  expert  be  called  a  psychiatrist.  In  a  some- 
what revolutionary  way  the  suggestion  was  at  that  time  made 
that  the  records  on  mental  cases  might  run  as  follows.  (The 
reader  must  take  note  that  these  suggestions  have  not  to  any 
extent  been  applied  practically  up  to  this  time  and  are  here 
offered  purely  to  bring  out  the  existence  of  border-line  cases 
of  mental  disease  that  are  not  medic o-le gaily  insane.) 

Example  i. — "As  alienist  I  consider  this  person  insane.  As 
psychiatrist  I  consider  this  patient  subject  to  general  paresis." 

Example  2.- — -"As  alienist  I  consider  this  person  sane.  As 
psychiatrist  I  consider  him  in  complete  mental  health." 

Example  3. — "As  alienist  I  consider  this  person  sane.  As 
psychiatrist  I  consider  him  subject  to  mental  disease;  namely, 
subject  to  a  psychoneurosis  of  hysterical  form." 

Exa'mple  4. — "As  alienist  I  consider  this  person  sane.  As 
psychiatrist  I  consider  him  subject  to  dementia  praecox  in  a 
mild  degree." 

Example  5. — "As  alienist  I  consider  this  person  sane.  As 
psychiatrist  I  consider  him  subject  to  paranoia  of  great  severity. 
This  mental  disease  (which  I  find  as  psychiatrist)  I  regard,  in 
this  case,  as  of  no  public  interest  (when  I  review  the  findings 
as  alienist)." 


ALIENISTS 
Field:  Insanity,  The  Insane 

Field :  Public,   Governmental, 
Legal 

Field :  Opinion  for  Court  Use 


Decisions   Alternative :     San- 
ity versus  Insanity 


Insanity  Implies  Mental  Dis- 
ease 

Sanity :  Insanity  =  i :  o 


PSYCHIATRISTS 

Field:  Psychiatry,  the  Men- 
tally Diseased 

Field:  Social,  Private,  Medi- 
cal 

Field :  Medical,  Psychological, 
and  Social  Diagnosis  and 
Treatment 

Decisions  Selective:  e.g., 
Syphilitic,  Feeble-minded, 
Epileptic,  Alcoholic,  Coarse 
Brain  Disease,  Sympto- 
matic, Senescent  -  senile. 
Schizophrenic,  Cyclothymic, 
Psychoneurotic,  etc. 

Sanity  Consistent  with  Mental 
Disease  of  Mild  Degree  or 
of  Special  Type 

Mental  Disease  of  All  De- 
grees of  Many  Kinds 


The  hypothetical  and  indeed  Utopian  reports  (Examples  1-5) 
are  made,  it  will  be  observed,  by  a  physician  who  announces 
himself  to  be  both  an  aHenist  and  a  psychiatrist.  No  doubt 
every  good  physician  must,  in  the  nature  of  things,  be  a  good 
alienist,  since  the  expert  in  mental  diseases,  as  a  rule,  must  be 
an  expert  in  those  mental  diseases  which  are,  from  the  legal 
point  of  view,  insanities.  No  doubt,  too,  every  alienist  (in  the 
narrow  legal  sense  here  adopted)  ought  to  be  a  good  psychia- 
trist. Yet  it  is  still  true  that  many  alienists  are  to  be  found 
who  have  no  interest  in  mental  diseases  outside  the  field  of  the 
medico-legal  insanities,  and  having  no  interest  (especially  no 
therapeutic  interest)  therein  really  never  do  become  psychia- 
trists in  a  deep  sense.  This  unfortunate  state  of  affairs  will 
persist  in  most  states  until  the  best  available  technique  for 
handling  border-line  cases  (namely  the  psychopathic  hospital) 
is  established.  We  place  upon  another  page  in  parallel  columns 
several  of  these  points. 

As  we  have  throughout  insisted,  psychiatry  is  an  art,  a 
branch  of  practical  medicine.  Yet  it  cannot  be  denied  that 
there  are  many  generalities  about  psychiatry  which  go  to  make 
up  a  respectable  body  of  theory.  Some  authors  distinguish  a 
special  psychiatry  from  a  general  psychiatry,  the  former  con- 
taining descriptions  of  separate  forms  of  mental  disease  and 
the  latter  presenting  a  variety  of  general  statements.  The  bet- 
ter usage  is  to  apply  the  term  "psychopathology"  to  the  body 
of  scientific  theory  which  has  been  built  up  out  of  psychiatry 
taken  in  relation  to  medicine,  psychology,  and  other  mental 
sciences  as  a  whole.  The  best  usage  would  define  the  psycho- 
pathologist  as  a  theorist  in  mental  disease  and  the  psychiatrist 
as  a  practitioner  therein.  To  be  sure  every  practitioner  needs 
a  body  of  theory  to  go  upon  and  must  therefore  be  trained  in 
psychopathology.  The  reverse  is,  no  doubt,  not  at  all  the  case ; 
and  non-practitioners,  even  non-medical  men,  have  made  enor- 
mous additions  to  our  knowledge  of  the  theory  of  mental 
disease.  The  lay  reader  who  dips  into  modern  works  on  the 
topic  of  psychiatry  will  almost  always  find  long  sections  deal- 

443 


444  THE    KINGDOM    OF    EVILS 

ing  with  "general"  psychiatry  or  with  psychopathology  and 
will  find  therein  descriptions  of,  for  example,  hallucinations, 
delusions,  morbid  emotions,  and  will-disorders  taken  in  a  gen- 
eral way  and  outside  their  setting  in  the  special  forms  of  men- 
tal disease.  The  lay  reader  must  be  warned  against  trans- 
ferring ideas  from  these  theoretical  parts  of  textbooks  directly 
to  the  patients.  On  the  other  hand  it  is  rather  easy  for  the 
lay  reader  to  gain  some  notion  of  the  special  forms  of  mental 
disease  in  their  larger  outlines.  Indeed  we  have  known  medical 
students,  social  workers,  psychologists,  and  even  jurists  who 
possessed  more  exact  ideas  about  some  forms  of  mental  disease 
than  do  many  general  practitioners  of  medicine. 

A  word  concerning  clinical  neurology.  Medical  school  cur- 
ricula, national  medical  associations,  and  a  variety  of  textbooks 
assure  us  of  the  existence  of  a  field  of  nervous  diseases  sepa- 
rate from  that  of  mental  diseases.  The  relations  here  are  a 
little  difficult  for  the  lay  reader  to  grasp.  The  mind  has  close 
relations  with  the  nervous  system,  and  the  term  neurology 
seems  to  specify  a  science  of  everything  nervous.  Accordingly 
the  neurologist  living  up  to  the  Greek  roots  of  his  professional 
title  is  apt  tp  regard  himself  as  ex  officio  a  psychiatrist.  On 
the  other  hand  the  psychiatrist  in  his  practical  diagnostic  work 
has  to  use  many  of  the  coarser  methods  of  the  neurologist  and 
finds  himself  nolens  volens  in  the  end  a  sort  of  neurologist. 

In  the  Great  War  the  surgeon  general  of  the  army  developed 
a  division  of  neurology  and  psychiatry,  and  practically  no  dis- 
tinction was  made  between  the  officers  working  under  this 
division.  In  fact,  they  were  often  termed  neuro psychiatrists. 
Some  think  that  a  new  art  of  neuropsychiatry  combining  the 
neurological  and  psychiatric  branches  of  older  medicine  is  to 
be  established.  This  is  not  the  place  to  discuss  or  to  define 
the  fields  of  clinical  neurology  and  psychiatry.  After  all,  both 
the  clinical  neurologist  and  the  psychiatrist  are  physicians  and 
have  the  same  fundamental  medical  training.  Many  men  unite 
theoretical  and  practical  knowledge  in  two  fields.  The  senior 
author  of  this  work  has  elsewhere  tried  to  define  the  present- 
day  differences  in  these  two  types  of  professional  men  by  de- 
scribing the  clinical  neurologists  as  rather  more  analytical  and 
the  psychiatrists  as  rather  more  synthetical  in  their  viewpoints. 
This  means  to  say  that  the  clinical  neurologist  is  on  the  whole 
rather  more  apt  to  leave  his  patient  a  mass  of  reflexes,  and  the 


THE    KINGDOM    OF   EVILS  445 

psychiatrist  is  rather  more  apt  to  talk  of  his  patient  in  general 
terms.  It  is  easy  to  see  that  each  method  readily  slips  into  over- 
emphasis of  details  or  generalities.  The  middle  of  the  road 
must  be  taken. 

We  pass  to  a  brief  summary  of  the  major  forms  of  mental 
diseases  as  they  occur  in  practice.  It  is  customary  to  say  that 
textbooks  on  psychiatry  greatly  disagree  upon  their  subject 
matter.  But  there  is  far  more  disagreement  upon  terms  than 
upon  facts.  And  there  is  naturally  far  more  disagreement 
about  details  than  about  the  major  groups  of  mental  disease. 
The  cases  in  Book  III  have  been  presented  in  groups  which  are 
found  in  most  textbooks  of  psychiatry.  These  groups  are  pre- 
sented in  a  special  order.  We  do  not  here  need  to  argue  for 
the  virtues  of  an  orderly  approach  in  diagnosis,  since  our  entire 
work  must  be  regarded  as  perfectly  hopeless  if  the  reader  has 
not  been  convinced  of  the  value  of  the  orderly  approach  as 
shown  in  Book  I  and  especially  in  Book  II.  The  value  of 
order  in  the  world's  work  is  a  truism.  The  orderly  diagnosis 
of  mental  disease  is  as  valuable  a  method  as  the  orderly  diag- 
nosis of  the  social  factors  which  we  have  grouped  in  this 
book  under  the  title  of  the  Forms  of  Evil.  In  fact  the  impulse 
to  the  classification  of  evils  herein  adopted  was  derived  from 
the  senior  author's  work  on  the  orderly  diagnosis  of  mental 
diseases. 

We  have  thrown  our  cases  into  eleven  groups,  of  which  the 
eleventh  is  a  miscellaneous  or  rag-bag  group  of  mental  dis- 
eases either  severe  or  mild  (but  for  the  most  part  mild)  that 
do  not  fit  the  definitions  of  the  other  ten  major  groups  of 
mental  disease.  This  eleventh  miscellaneous  group  would  be 
of  special  abhorrence  to  the  old-time  alienist  limited  in  his 
view  of  mental  disease  to  the  notion  of  medico-legal  insanity. 
The  old-time  alienist  who  cannot  think  of  insanity  except  in 
terms  of  internment  in  an  asylum  or  of  testamentary  incapac- 
ity, cannot  readily  be  got  to  deal  with  the  psychopathic  per- 
sonalities and  other  disorders  of  this  eleventh  group.  It  is 
somewhat  as  if  the  general  practitioner  of  medicine  should 
refuse  to  consider  any  case  of  disease  which  was  not  bedridden. 
The  eleventh  group  of  the  psychopathies,  psychopathic  person- 
alities, etc.,  must  comprise,  it  will  be  seen,  many  of  the  cases 
of  mild  and  dubious  mental  disease  which  the  modern  psycho- 
pathic hospital  has  been  especially  established  to  class  and  treat. 


446  THE   KINGDOM    OF    EVILS 

The  eleventh  group  is  placed  last,  because  the  attempt  should 
be  made  to  class  every  mental  suspect  more  definitely  in  one  of 
the  preceding  groups.  Concerning  these  preceding  ten  groups, 
it  is  worth  while  to  insist  that  nothing  ultimate  is  claimed 
either  for  the  number  or  the  nature  or  the  special  order  of  the 
groups.  That  some  order  of  disease  groups  should  be  adopted 
for  the  purposes  of  diagnosis  is  highly  desirable.  That  this 
particular  order  is  the  best  at  the  present  day  is  perhaps  doubt- 
ful. Nor  will  anyone  maintain  that  this  particular  order  will 
outlast  the  decade. 

The  first  four  groups  in  this  sequence  are  of  particular  social 
interest.  The  first  group  contains  the  mental  diseases  due  to 
syphilis,  a  group  of  diseases  of  increasing  importance  in  prac- 
tical psychiatry  and  the  bridge  over  which  the  new  associations 
between  mental  hygiene  and  public  health  will  pass  owing  to 
the  fact  that  the  most  concrete  contributions  to  the  technique 
of  mental  hygiene  have  been  made  in  this  field.  Nor  can  any- 
one doubt  that  feeble-mindedness  is  a  leading  social  problem. 
Epilepsy,  particularly  in  its  milder  and  so-called  "equivalent" 
forms,  is  another  topic  of  social  interest  both  because  public 
institutions  must  always  eventually  be  built  for  epileptics  of  a 
given  state  and  because  there  are  always  so  many  "sane"  epi- 
leptics who  are  in  no  sense  asylum  cases  but  are  very  proper  sub- 
jects for  social  work  and  mental  hygiene.  Fourthly,  alcohol- 
ism is,  or  has  been  in  this  country  up  to  the  passage  of  the 
national  prohibition  legislation,  a  most  important  social  factor 
of  mental  hygiene.  Inasmuch  as  the  group  here  defined  con- 
tains the  drug  addicts  (so  far  as  drugs  produce  mental  dis- 
ease and  disorder),  the  group  may,  no  doubt,  always  remain  of 
practical  social  significance. 

Though  the  main  reason  for  arranging  these  disease  groups 
in  this  particular  order  (first  proposed  in  191 7)  was  the 
reliability  of  tests  and  other  diagnostic  criteria  in  the  groups, 
yet  the  order  was  adopted  with  a  weather  eye  to  the  social 
values  of  the  groups.  If  the  psychiatrist  could  be  made  to  con- 
sider definitely  such  socially  interesting  matters  as  (a)  syphilis, 
(b)  feeble-mindedness,  (c)  epilepsy,  (d)  alcohol  and  drugs, 
the  battle  was  almost  won  for  a  broad  conception  of  psychiatry. 
If  the  psychiatrist  was  compelled  by  routine  to  learn  whether 
his  mental  patient  was  syphilitic,  he  was  compelled  to  resort  to 
laboratory  methods  of  a  certain  refinement.     If  he  took  seri- 


THE    KINGDOM    OF    EViLS  447 

ously  the  question  of  feeble-mindedness,  he  had  perforce  to 
resort  to  standardized  methods  of  mental  testing.  If  he  was 
to  make  up  his  mind  about  either  epilepsy  or  alcoholism  he  had 
to  have  by  him  the  means  of  securing  a  social  history.  In  short, 
the  psychiatrist  who  should  deal  scientifically  with  the  ques- 
tions raised  in  these  first  four  groups  would  have  to  have  at  his 
command  the  services  of  a  proper  modern  clinical  laboratory, 
the  resources  of  a  psychological  service,  and  the  resources  of 
psychiatric  social  work. 

It  will  be  known,  even  to  the  layman  who  has  had  contacts 
with  this  field,  that  the  majority  of  cases  in  these  first  four 
groups  are  cases  of  the  so-called  "organic"  type.  That  is  to 
say,  these  cases  will  be  found  upon  autopsy  to  show  serious 
disorder  of  the  nervous  system  which  can  be  demonstrated 
either  by  the  naked  eye  or  by  the  microscope.  In  fact  the 
whole  table  of  groups  is  found  to  have,  roughly  speaking,  the 
property  of  being  more  "organic"  at  its  upper  end  and  more 
"functional"  at  its  lower  end.  But  the  sequence  was  not  chosen 
upon  this  particular  basis,  but  rather,  as  stated  above,  on  the 
basis  of  the  reliability  of  diagnostic  tests  and  criteria.  Above 
all,  the  lay  reader  should  not  conclude  that  "organic"  means 
incurable  or  permanent  as  to  symptoms. 

The  fifth  group  is  a  group  of  mental  diseases  in  which  the 
brain  shows  demonstrable  lesions.  It  is  the  "organic"  group 
par  excellence  with  the  syphilitic,  feeble-minded,  and  epileptic 
cases  removed  therefrom.  The  sixth  group  is  a  group  of 
mental  diseases  in  which  the  brain  is  relatively  normal  and  in 
which  the  cause  seems  to  reside  outside  the  brain  in  some  one 
or  more  organs  of  the  body.  So  far  as  asylum  material  goes 
this  group  of  somatic  cases  has  seemed  up  to  recent  times  to 
be  limited.  The  seventh  group  is  the  group  of  the  senile  psy- 
choses. The  remaining  three  groups  deal  with  topics  of  great 
difficulty  and  of  doubtful  scientific  standing  even  today.  The 
eighth  and  ninth  groups  of  the  so-called  dementia  praecox  and 
of  manic-depressive  psychosis  are  groups  whose  distinction  is 
a  practical  matter  of  difficult  diagnosis  almost  daily  in  every 
hospital  for  the  insane  and  even  more  so  in  psychopathic  hos- 
pitals. These  two  disease  groups  may  be  regarded  as  "sister" 
groups  of  mental  disease.  The  tenth  group  is  that  of  the  psy- 
choneuroses,  Avith  which  the  reader  of  the  first  three  books  has 
to  become  familiar,  in  striking  instances  in  which  mental  fac- 


448  THE    KINGDOM    OF    EVII^ 

tors,  operating  apparently  by  themselves,  have  directly  pro- 
duced mental  disorders.  So  far  as  we  are  aware,  practically 
every  psychiatrist  of  today  recognizes  the  existence  of  these 
major  groups  or  of  their  most  important  single  representatives 
amongst  the  diseases. 

The  alert  reader  may  well  have  inquired  long  before  this 
point  in  our  exposition  whether  a  patient  may  not  fall  into  two 
or  more  of  these  groups.  Let  us  emphatically  say  that  it  is 
entirely  possible  that  a  patient  shall  be  syphilitic,  feeble-minded, 
epileptic,  alcoholic,  a  victim  of  coarse  brain  injury,  a  victim  of 
somatic  disorder  operating  from  outside  the  nervous  system 
and  a  senile ;  that  is,  a  patient  may  possess  characteristics  that 
fall  in  every  one  of  the  first  seven  groups.  To  be  sure  it  may 
be  better  to  describe  him  chronologically.  He  inight  be  de- 
scribed as  a  feeble-minded  person  whose  brain  lesion  was  such 
as  to  have  produced  epilepsy,  who  had  not  only  acquired  syphilis 
of  the  nervous  system  but  had  sundry  other  destructive  in- 
juries of  his  brain  and  who  had,  in  the  vicissitudes  of  life, 
become  alcoholic,  had  developed  diseases  in  the  body  at  large 
which  had  in  turn  reflected  themselves  in  the  patient's  mind 
and  who  had  at  last  become  senile  in  such  wise  that  the  senile 
brain  changes  were  contributing  a  dementia  to  the  already 
complicated  picture.  To  be  sure  for  the  present  we  have  no 
such  case  to  offer,  and  such  extensive  combinations  of  factors 
are,  no  doubt,  rare.  But  can  we  continue  to  catalogue  on  a 
theoretical  basis?  Is  it,  for  example,  possible  for  a  feeble- 
minded person  to  become  a  victim  of  dementia  praecox?  The 
answer  to  this  question  cannot  be  given  with  certainty  at  this 
time;  but  on  the  whole  there  is  considerable  evidence  for  an 
affirmative  answer,  and  some  authors  freely  assert  that  de- 
mentia praecox  may  be  grafted  upon  feeble-mindedness.  As 
for  manic-depressive  psychosis  its  phenomena  are  found  in  the 
majority  of  mental  diseases,  which  may  develop  periodical 
emotional  disturbances ;  but  it  is  doubtful  whether  we  should 
term  all  such  instances  of  an  apparently  cyclothymic  nature 
cases  of  manic-depressive  psychosis.  As  for  the  psychoneu- 
roses,  no  doubt  they  can  develop  upon  any  or  all  of  the  bases 
above  enumerated.  But  if  a  case  of  mental  disease  exhibits 
phenomena  that  might,  at  first  glance,  place  him  in  one  of  the 
lower  groups  in  our  sequence,  then,  in  fact,  it  is  the  usual  rule 
to  give  him  the  diagnosis  of  the  earliest  group  to  which  he  can 


THE    KINGDOM    OF    EVILS  449 

be  found  related.  This  is  probably  on  account  of  the  prag- 
matic and  therapeutic  value  of  so  classing  the  patient. 

Let  us  indicate  some  of  the  more  important  social  values  of 
these  groups. 

Group  I,  the  syphilitic  group  of  mental  disorders,  is  a  very 
important  one  to  the  social  worker.  In  the  first  place  the 
establishment  of  the  diagnosis  almost  always  means  the  pos- 
sible suggestion  of  treatment,  which  treatment  may  be  rela- 
tively expensive  and  sometimes  hard  to  persuade  the  patient  to 
take.  In  the  next  place,  the  spouse  and  children  of  the  neuro- 
syphilitic  need  examination  to  determine  whether  they  are  not 
likewise  infected  with  syphilis.  If  so,  they  can  come  before 
they  have  developed  mental  symptoms  and  in  their  own  interest 
be  treated  in  suitable  clinics  or  otherwise.  It  is  the  task  of 
the  social  worker  to  see  that  this  family  work  in  neurosyphilis 
be  carried  out.  Some  of  the  points  in  this  work  have  been  set 
forth  in  a  work  by  Southard  and  Solomon  entitled  Neurosyph- 
ilis, Modern  Systematic  Diagnosis  and  Treatment  (191 7),  one 
whole  section  of  which  is  devoted  to  medico-legal  and  social 
problems.  Some  of  the  cases  in  this  book  have  been  presented 
again  in  this  work  redescribed  from  the  standpoint  of  social 
work.  This  group  is  the  group  of  the  popularly  known  dis- 
ease, general  paresis,  sometimes  known  as  "softening  of  the 
brain."  Southard  and  Solomon  in  191 7  reported  that  some- 
thing like  twenty-five  per  cent  of  their  cases  of  general  paresis 
yielded  considerably  to  treatment.  This  percentage  is  higher 
than  other  authenticated  percentages.  Perhaps  the  lay  reader 
will  not  be  too  much  impressed  with  a  twenty-five  per  cent 
yield  of  therapeutic  successes;  but  if  the  layman  considers  the 
results  in  chronic  diseases  in  general  and  remembers  that  this 
disease  comes  as  a  rule  ten  years  after  the  initial  infection  with 
syphilis,  he  will  see  that  such  results  as  twenty-five  per  cent 
recoveries  are  important. 

The  social  values  of  Group  II,  of  the  feeble-minded,  are 
too  much  in  the  public  eye  at  the  present  moment  to  require 
exposition  here.  Not  only  have  the  psychologists  following 
Binet  produced  mental  tests  of  value  but  these  tests  have  been 
very  widely  employed  by  the  more  or  less  competent  lay  work- 
ers and  the  whole  topic  has  absorbed  public  interest.  The 
articulation  of  this  problem  with  the  problems  of  crime  and 
prostitution  is  well  known,  not  to  say  overdrawn,  in  the  public 


450  THE    KINGDOM    OF    EVILS 

prints.  Practically  half  of  the  prostitutes  examined  by  the 
White  Slave  Traffic  Commission  of  Massachusetts  turned  out 
to  be  in  some  degree  feeble-minded. 

Concerning  Group  III,  note  was  made  above  of  the  popular 
interest  in  the  "sane  epileptic."  Some  authors  have  empha- 
sized the  relation  of  the  so-called  epileptic  personality  with  its 
very  pronounced  egotism  and  ill-humor.  Doubtless  in  this  field 
there  will  be  much  scope  for  mental  hygiene  in  the  future. 
But  the  social  worker  can  do  the  most  good  by  remembering 
that  epilepsy  has  a  large  number  of  subgroups.  The  formula 
to  bear  in  mind  is  that  it  is  much  truer  to  speak  of  "epilepsies" 
than  of  "epilepsy." 

Concerning  Group  IV,  the  alcoholic  group  and  the  drug 
group,  we  have  at  times  referred  to  the  special  values  of  the 
Men's  Club  as  employed  for  some  years  at  the  Psychopathic 
Hospital  in  Boston.  But  the  idea  is  an  old  one.  The  Salvation 
Army  has  in  the  past  done  much  good  in  the  rescue  of  alco- 
holics from  their  habits.  The  victim  of  delirium  tremens  is 
an  especially  good  social  risk,  as  he  often  cooperates  extremely 
well  upon  recovery. 

Groups  V,  VI,  and  VII  are  of  lesser  social  importance  since 
for  the  most  part  the  problems  that  arise  therein  are  either 
not  at  all  to  be  settled  by  social  work  or  else  can  be  settled 
with  considerable  ease. 

Groups  VIII,  IX,  X  (that  is,  dementia  praecox.  manic-de- 
pressive psychosis,  and  psychoneurosis)  become  once  more  of 
prime  interest  to  the  social  worker.  Dementia  praecox  and 
manic-depressive  cases  are  constantly  apt  to  fall  into  the  dubious 
position,  whether  they  require  interning  in  an  asylum  or  do  not. 
The  relations  of  the  friends  to  this  situation  then  become  criti- 
cal. Apparently  a  multitude  of  adjustments  may  need  to  be 
made  in  these  groups  by  the  social  worker.  Mild  cases  of  both 
of  these  diseases,  but  especially  of  the  manic-depressive  group, 
often  want  to  go  home  prematurely  and  often  do  go  home 
against  the  advice  of  the  physicians.  The  social  worker  may 
here  become  of  great  practical  value.  Somehow  the  laity  is 
rather  apt  to  regard  the  psychiatrist  as  a  kind  of  ogre  who 
wishes  to  get  even  the  mildest  and  most  doubtful  psychop- 
athies into  his  institutional  net  for  safe-keeping  or  observation. 
The  social  worker  can  help  to  dissolve  this  idea  of  something 
ogreish  in  the  psychiatrist.     Patients  recovering  from  depres- 


THE    KINGDOM    OF    EVILS  45 1 

sion  (manic-depressive  psychoses)  are  particularly  difficult 
cases  to  handle.  During  convalescence  these  patients  are  ap- 
proximately normal;  yet  at  a  time  when  the  depression  still 
persists  but  the  power  of  the  will  has  steadily  increased  comes 
the  zone  of  danger  of  suicide.  The  patient  is  still  dominated 
by  depressing  thoughts  but  is  no  longer  protected  against  sui- 
cide by  the  weakness  of  will  which  prevailed  in  the  peak  of 
his  illness.  The  relatives  need  to  be  convinced  that  their  patient 
should  be  retained  in  hospital  a  few  weeks  longer  to  pass 
through  this  zone  of  will  weakness. 

Finally  nothing  in  this  book  has  been  more  convincing  than 
the  need  of  social  work  in  the  field  of  psychopathic  personalties, 
here  grouped  in  the  last  Group  XI. 

Now  and  then  from  a  general  social  worker  comes  a  request 
for  lists  of  symptoms  by  which,  supposedly,  the  different  men- 
tal diseases  may  be  recognized.  Social  workers  who  have 
dipped  into  works  upon  psychiatry  can  follow  us  when  we  say 
it  is  not  at  all  impossible  to  match  the  symptoms  of  any  dis- 
ease which  we  may  confront  with  the  symptoms  of  several  dis- 
eases as  described  in  the  medical  books.  In  fact,  the  more 
thorough  and  accurate  the  psychiatric  textbook,  the  more  likely 
would  be  the  facts  in  the  particular  case  to  match  with  the  facts 
in  the  books  as  presented  under  a  great  variety  of  headings.  It 
is  not  alone  the  tyro,  but  also  the  expert,  who  is  amazed  to  find 
that  all  the  symptoms  in  his  case  can  be  found,  let  us  say, 
under  the  different  headings  of  syphilis,  dementia  praecox, 
manic-depressive  psychosis,  etc.  To  use  the  language  of  medi- 
cal logic,  we  can-  briefly  put  the  situation  by  saying  that  in  the 
field  of  mental  diseases,  there  are  few  or  no  indicator  symp- 
toms. Any  symptom,  e.g.,  mania,  depression,  persecutory 
ideas,  grandiosity,  hallucinations,  and  so  on  through  the  list, 
may  be  found  alone  or  even  in  multiple  combination  with  other 
symptoms  of  the  list  in  virtually  any  one  of  the  great  groups 
of  mental  diseases. 

A  good  many  persons  believe  that  a  disease  is  composed  of 
symptoms,  but  nothing  is  more  erroneous.  The  symptom  indi- 
cates the  disease.  The  disease  is  an  infinite  mass  of  processes 
and  of  arrangements.  It  is  a  mistake  to  think  that  because  it 
can  be  shown  that  general  paresis  has  a  certain  kind  of  pupil- 
lary disorder  and  a  certain  kind  of  speech  disorder,  and  a  cer- 
tain mental  state  characterized  by  feelings  of  grandeur,  these 


452  THE    KINGDOM    OF    EVILS 

three  things,  disorder  of  pupils,  disorder  of  speech,  delusions 
of  grandeur,  in  any  sense  constitute  the  disease.  No  symptom 
constitutes  the  disease.  No  group  of  symptoms  constitutes  a 
disease.  One  rather  comforting  fact  about  mental  disease  is 
that,  after  all,  there  are  so  few  symptoms  to  a  given  disease. 
The  most  complicated  disease  that  runs  through  the  entire 
make-up  of  the  person,  influences  every  move  of  his  entire 
future,  goes  back  to  his  entire  past,  will  be  found  to  have  but 
one  symptom,  or  two  or  three,  rarely  more  than  ten  or  a  dozen 
symptoms.  These  must  be,  in  the  nature  of  things,  mere  indi- 
cators of  the  situation. 

In  short  there  are  no  indicator  symptoms,  or  what  are  called 
in  the  books  pathognomonic  symptoms.  In  medicine  there  are 
certain  pathognomonic  symptoms;  thus  in  smallpox,  the  pock 
of  smallpox  is  pathognomonic;  it  does  not  occur  in  any  other 
disease,  and  you  get  it  when  you  have  that  disease.  Of  course 
there  are  some  doubtful  cases  where  you  cannot  make  out 
whether  you  have  got  a  pock  or  not  of  this  characteristic  sort. 
The  pock  of  smallpox  is  so  characteristic  that  we  regard  it  as 
pathognomonic.  The  tubercle  bacillus  in  tuberculosis  is  pathog- 
nomonic,— it  does  not  occur  except  in  tuberculosis.  But  in 
mental  disease  we  have  not  any  such  pathognomonic  symptoms 
that  point  to  any  certain  disease. 

There  are  a  few  combinations  of  symptoms  or  signs  that 
indicate  certain  diseases.  However,  these  combinations  are 
probably  beyond  the  range  of  a  person  not  trained  in  medicine 
to  use.  There  may  be  ope  or  two  small  exceptions  to  this  in 
the  whole  of  medicine.  A  nurse,  a  layman,  anyone  can  learn 
to  diagnosticate  smallpox  from  the  pock  just  as  well  and  per- 
haps better  than  a  physician.  Just  as  a  man  without  knowing 
a  thing  about  engineering  says  about  his  automobile  "the  en- 
gine is  skipping."  The  man  may  not  know  what  to  do  about 
it,  or  he  may,  without  knowing  anything  about  engineering,  be 
able  to  fix  it ;  so  that  people  ca,n  make  certain  diagnoses  which 
are  merely  recognitions  of  things,  of  data.  But  when  it  comes 
to  mental  disease  this  is  not  so.  There  are  not  any  simple 
points  by  which  to  recognize  it,  and  its  complicated  ways  are 
not  too  easy  for  the  medical  mind  or  for  any  other  mind. 


MAIN  FORMS  OF  NEUROSYPHILIS 

DIFFUSE  NEUROSYPHILIS 

(non-vascular  forms  of  "cerebral,"  "spinal,"  and  "cere- 
brospinal syphilis") 

VASCULAR  NEUROSYPHILIS 

("cerebral  arteriosclerosis,"   "cerebral  thrombosis") 

PARETIC  NEUROSYPHILIS 
("general  paresis") 

TABETIC  NEUROSYPHILIS 
("tabes  dorsalis") 

GUMMATOUS  NEUROSYPHILIS 

("gumma  of  membranes,  of  brain") 

JUVENILE  NEUROSYPHILIS 
(paretic,  tabetic,  diffuse) 


NEUROSYPHILIS 

The  problems  of  neurosyphilis  (Group  I)  are  presented  in 
eight  cases  (39  to  46)  at  the  beginning  of  Book  III.  In  the 
book  of  the  senior  author  written  in  collaboration  with  Dr.  H. 
C.  Solomon,  Neitrosyphilis:  Modern  Systematic  Diagnosis  and 
Treatment  presented  in  one  hundred  and  thirty-seven  case  his- 
tories, there  had  already  been  given  sixteen  cases  of  neuro- 
syphilis having  medico-legal  social  interests  in  the  foreground. 
Numerous  other  cases  in  that  series  also  possessed  social  inter- 
est. Case  39  of  our  present  series,  Greeley  Harrison,  was 
case  9  of  the  book  Neurosyphilis.  Greta  Meyer  (case  40), 
Walter  Heinmas  (case  41),  David  Collins  (case  42),  Archi- 
bald Sherry  (case  45)  were  also  all  cases  from  the  Neuro- 
syphilis book,  being  cases  107,  97,  61,  and  38.  A  whole  vol- 
ume might  be  written  concerning  the  social  aspects  of  the  prob- 
lem of  neurosyphilis.  The  lay  reader  must  bear  in  mind  that 
the  medical  men  are  apt  to  term  protean  the  nature  of  neuro- 
syphilis. Practically  every  form  of  mental  disease  can  be 
imitated  by  syphilis  of  the  nervous  system.  Lesions  pro- 
duced by  the  spirochsete  in  the  nervous  system  are  of  several 
kinds  and  of  widely  varying  degree.  In  the  first  place  syphilis 
may  affect  the  membranes  that  surround  the  nervous  system 
giving  rise  to  the  various  forms  of  meningeal  syphilis  (both  the 
delicate  pia  mater  that  immediately  invests  the  brain  and  spinal 
cord  and  the  thicker  dura  mater  that  overlies  the  pia  mater  are 
affected  by  lesions  that  may  be  either  isolated  or  widespread). 
The  blood  vessels  of  the  brain  and  spinal  cord  may  be  the  par- 
ticular target  of  attack  by  the  spirochsetes  and  the  lesions  of 
these  blood  vessels  may  give  rise  to  destruction  of  the  brain 
and  spinal-cord  tissues  which  they  supply  with  blood.  Again, 
when  neither  the  investing  membranes  nor  the  blood  vessels 
are  severely  or  at  all  affected,  the  tissues  themselves  may  be  the 
point  of  attack  by  the  spirochsete. 

We  present  upon  page  453  the  main  forms  of  neuro- 
syphilis as  classified  for  practical  purposes  in  the  above  men- 
tioned book  of  Southard  and  Solomon.     Of  these  six  main 

455 


456  THE    KINGDOM    OF    EVILS 

forms  of  neurosyphilis  we  illustrate  in  the  present  volume  five 
forms.  The  form  omitted  from  the  present  volume  is  the 
form  known  as  gummatous  neurosyphilis,  that  is  a  gumma  of 
the  membranes  of  the  brain.  This  lesion  is  sometimes  open  to 
surgical  attack  and  sometimes  to  treatment  by  antisyphilitic 
drugs,  such  as  salvarsan,  mercury,  and  the  like ;  but  the  prob- 
lems of  the  disease  would  have  nothing  of  special  interest  from 
the  social  standpoint.  Diffuse  neurosyphilis  is  represented  in 
this  volume  by  Greta  Meyer  (case  40).  This  disease  may  be 
a  long-standing  one.  There  is  no  prognosis  of  comparatively 
early  death  such  as  attends  the  diagnosis  of  general  paresis 
represented  in  our  series  by  Greeley  Harrison  (case  39),  Hein- 
mas  (case  41),  Collins  (case  42),  Spindler  (case  43).  In 
cases  of  diffuse  neurosyphilis,  such  as  that  of  Greta  Meyer,  ac- 
cordingly the  social  worker  may  look  for  a  long  history  of 
gradual  development,  numerous  variations,  remissions,  and 
an  outlook  of  considerable  success  in  medical  treatment.  With 
respect  to  the  paretic  form  of  neurosyphilis,  commonly  called 
general  paresis,  we  have  brought  out  in  our  discussion  of  Gree- 
ley Harrison  (case  40)  that  the  paretic  form  of  neurosyphilis 
is  not  necessarily  completely  intractable  to  treatment.  We 
here  point  out  that  this  point  is  a  most  important  conception 
not  yet  well  established  in  the  medical  mind.  Southard  and 
Solomon  felt  from  their  work  published  in  191 7  that  intensive 
treatment  had  proved  to  be  of  the  greatest  value  in  a  number 
of  cases  of  general  paresis.  They  felt  that  they  had  cured  an 
excellent  salesman  of  forty-six  years  of  age  who  had  suffered 
from  most  aggravated  mental  symptoms.  He  not  only  recov- 
ered symptomatically  but  all  his  tests  have  been  rendered  nega- 
tive and  he  has  remained  entirely  well  and  economically  effi- 
cient for  about  five  years  even  without  further  treatment. 

Southard  and  Solomon  pointed  out  also  that  two  or  three 
months  of  active  treatment  will  often  be  carried  out  before 
any  signs  of  improvement  whatever  are  seen.  They  con- 
cluded that  it  was  "unfair"  to  give  an  entirely  grave  prog- 
nosis in  any  case  of  neurosyphilis  until  the  effect  of  treat- 
ment had  been  tried.  But  whatever  the  outcome  of  the  medi- 
cal treatment  of  neurosyphilis  in  any  of  its  forms,  we  can  hope 
to  prove  in  the  present  volume  that  social  treatment  yields 
efficient  results  and  should  be  carried  out  even  if  the  medical 
prognosis  be  regarded  as  grave. 


THE    KINGDOM    OF    EVILS  457 

The  case  of  Walter  Heinmas  is  a  particular  one  from  the 
standpoint  of  the  social  worker.  As  we  pointed  out,  the  rather 
obvious  motto  should  be  adopted  by  social  workers,  namely, — 
the  families  of  paretics  are  the  families  of  syphilitics.  This 
motto  should  be  followed  by  action.  This  action  should  con- 
sist in  having  the  blood  serum  of  each  member  of  the  family 
of  the  paretic  (that  is,  his  spouse  and  children)  examined  by 
blood  tests  for  syphilis.  The  two  children  of  Walter  Heinmas 
had  fortunately  been  absolutely  healthy.  The  patient  himself 
and  his  wife  had  no  idea  that  there  had  ever  been  syphilis  and 
could  remember  no  symptoms  or  suspicions.  Mother  and 
daughter  were  well  endowed  in  mind  and  general  physical 
health,  yet  blood  tests  of  all  three  proved  positive  for  syphilis. 

The  case  of  David  Collins  is  particularly  valuable  for  the 
social  worker.  The  data  of  this  case  seemed  to  show  that 
neither  intense  medical  care  alone  nor  elaborate  social  care 
alone  would  ever  turn  the  trick.  Neither  form  of  treatment 
would  have  been  quite  justifiable  from  a  practical  point  of 
view  if  carried  out  alone.  Whatever  is  to  be  the  outcome  in  the 
case  of  David  Collins,  we  must  concede  that  partial  or  tem- 
porary cure  by  social  service  methods  must  be  scored  for  the 
Collins  family.  At  the  present  writing  we  have  a  history  of 
five  years  since  the  first  appearance  of  David  Collins  at  the 
hospital  after  his  falling  into  convulsions  on  the  street,  and  we 
have  a  history  of  three  years  since  the  initiation  of  a  period 
of  regular  treatment. 

Archibald  Sherry  (case  45)  is  a  very  unusual  case  medically, 
a  case  of  juvenile  tabes,  sometimes  known  as  locomotor  ataxia. 
Rather  good  therapeutic  results  were  obtained  for  this  twelve- 
year-old  boy,  although  social  work  was  difficult  by  reason  of 
lack  of  cooperation  on  the  part  of  the  child's  mother. 

Harold  Gordon  (case  46)  falls  into  the  group  of  vascular 
neurosyphilis  (see  table  of  main  forms).  These  cases  may  be 
completely  arrested  by  medical  treatment  leaving  a  certain  in- 
curable but  not  necessarily  incapacitating  impairment.  The 
point  of  these  results  lodges  in  the  fact  that  the  loss  of  power 
on  the  one  side  of  the  body  (hemiparaplegia)  is  due  to  lesions 
of  blood  vessels  in  the  brain,  which  lesions  may  be  cured  com- 
pletely by  antisyphilitic  treatment,  but  the  destruction  of  brain 
tissue  entailed  by  the  temporary  or  permanent  plugging  or  rup- 
ture of  the  artery  cannot  be  made  good.     Tissue  of  the  cen- 


45^  THE    KINGDOM    OF    EVILS 

tral  nervous  system,  once  destroyed,  cannot  be  regenerated. 
However,  the  victim  of  such  a  disease  as  syphiUtic  hemiparesis 
may  recover  without  excessive  impairment,  as  in  the  case  of 
Harold  Gordon. 

Neurosyphihs  is  then  one  of  the  most  protean  of  diseases. 
The  blood  test  for  syphilis  is  one  of  the  most  reliable,  if  not 
the  most  reliable,  single  blood  test  available  to  the  worker  in 
mental  disease.  Inasmuch  as  syphilis  of  the  nervous  system 
may  through  its  special  ways  of  affecting  brain  and  spinal  cord 
imitate  practically  every  other  kind  of  mental  disease  it  becomes 
important  to  eliminate  the  hypothesis  of  neurosyphilis  from 
virtually  all  cases  of  long-standing  mental  disease,  particularly 
if  this  disease  occurs  in  the  male  sex.  It  is  possible  for  the 
nervous  system  to  harbor  spirochsetes  that  cause  syphilis  with- 
out yielding  any  symptoms  whatever,  at  all  events  for  years 
or  even  decades.  We  sometimes  find  elaborate  evidence  for 
syphilis  of  the  nervous  system  in  persons  who  show  absolutely 
no  sign  or  symptom  of  nervous  disease.  But  again  spiro- 
chsetes  may  produce  extraordinary  effects  or  produce  huge 
tumor-like  masses  known  as  gummata.  These  gummata  are  in 
their  practical  effects  rather  more  like  tumors  than  like  most 
syphilitic  lesions. 

Again  it  would  seem  as  though  the  process  is  a  sort  of  siege 
of  the  nervous  system,  the  spirochaetes  affecting  certain  nerve 
tracts.  This  is  the  case  in  tabes  dorsalis  (locomotor  ataxia) 
where  the  destructive  process  is  largely  limited  to  the  posterior 
tracts  of  the  spinal  cord.  The  form  of  attack  in  diffuse  neuro- 
syphilis is  quite  different,  as  if  the  nervous  system  were  not 
so  much  attacked  by  siege  as  taken  by  storm,  and  the  results 
are  disseminated  over  a  large  area.  Again  neurosyphilis  is  a 
simple  secondary  effect  of  blood  vessel  disease  which  results  in 
the  scooping  out  of  huge  masses  of  tissue  which  die  and  give 
rise  to  so-called  secondary  degeneration  in  different  parts  of 
the  nervous  system.  These  lesions  or  spirochsetes  may  be  over- 
looked and  disappear  and  the  lesions  may  resemble  extin- 
guished volcanoes.  Yet  again  the  diffuse  process  may  run  on 
apparently  with  perfectly  fatal  results  to  mortality  in  a  few 
years  both  with  and  without  treatment.  However,  in  other 
cases,  as  we  have  insisted,  treatment  appears  to  accomplish 
much.  As  Southard  and  Solomon  insist,  the  prognosis  of 
neurosyphilis  is  not  worse  than  that  of  the  chronic  dis- 


THE    KINGDOM    OF    EVILS  459 

eases  in  general.  The  prognosis  of  neurosyphilis  so  far  as 
length  of  life  goes  is  certainly  not  bad.  Remissions  are  always 
possible  though  they  are  not  frequent.  We  found  amongst 
three  hundred  untreated  committed  cases  of  paretic  neuro- 
syphilis five  that  were  capable  of  self-support  and  ten  more 
that  seemed  normal  enough  to  live  at  home.  The  patients  were 
said  to  have  "remissions."  Perhaps  the  most  important  thing 
for  the  investigator  to  bear  in  mind  is  this :  During  a  good 
part  of  the  early  period  of  the  course  of  neurosyphilis,  it  is 
difficult  or  impossible  to  tell  the  paretic  from  the  non-paretic 
forms  of  diffuse  neurosyphilis  by  any  combination  or  single 
observations  and  tests.  In  short  we  should  take  any  diagnosis 
either  of  general  paresis  (with  its  outlook  that  the  patient  is 
going  to  die  in  from  three  to  five  years)  or  of  diffuse  neuro- 
syphilis (with  its  much  better  prognosis)  with  a  grain  of  salt. 
In  either  case,  however,  it  is  desirable  to  proceed  along  the  best 
lines  of  social  treatment  whatever  is  to  be  the  outcome  of  the 
neurosyphilitic.  In  each  instance  also  it  is  important  to  remem- 
ber the  other  members  of  the  family  and  to  submit  them  to 
blood  tests.  It  would  be  an  important  addition  to  the  tech- 
nique of  preventive  medicine  if  the  spouses  and  children  of 
all  paretics  were  subjected  to  blood  tests  for  their  own 
individual  interest  and  in  the  interest  of  the  health  of  the 
community. 


FEEBLE-MINDEDNESS 

FIELDS  OF  INQUIRY 

Physical  Examination 

Family  History 

Personal  and  Developmental  History 

School  Progress 

Examination  in  School  Work 

Practical  Knowledge 

Social  History  and  Reactions 

Economic  Efficiency 

Moral  Reactions 

Mental  Examination 

Walter  E.  Fernald,  191; 


FEEBLE-MINDEDNESS 

We  present  the  topic  of  social  work  in  connection  with 
feeble-mindedness  (Group  II  of  Book  III)  in  six  cases  (47- 
52)  in  Book  III.  But  the  topic  has  been  extensively  covered 
also  in  Books  I  and  II,  more  particularly  in  cases  2,  9,  11,  13, 
15.  26,  32,  35. 

The  social  worker  must  become  familiar  with  at  least  the 
generalities  concerning  the  major  subgroups  of  feeble-minded- 
ness from  the  standpoint  of  the  measurement  of  their  mental 
levels.  American  usage  counts  amongst  the  feeble-minded 
(a)  the  idiots  or  feeble-minded  of  the  lowest  grade,  (b)  the 
imbeciles  or  feeble-minded  of  middle  grade,  and  (c)  the  morons 
or  feeble-minded  proper.  (English  usage  often  employs  the 
term  feeble-minded  for  the  morons  only.)  Modern  work 
seems  to  show  that  between  the  feeble-minded  proper  or  so- 
called  morons  and  normal  persons  there  is  a  group  of  (d) 
subnormal  persons  measuring  by  mental  tests  at  a  higher  level 
than  the  morons.  If  this  new  definition  is  established,  we  shall 
then  count  from  below  upwards,  four  groups  of  the  "feeble- 
minded" ;  namely  idiots,  with  a  mental  level  corresponding  to 
that  of  infants;  imbeciles  with  a  mental  level  corresponding  to 
that  of  young  children ;  morons  with  a  mentality  corresponding 
to  that  of  older  children  before  puberty,  and  subnormal  persons 
with  a  higher  mentality  but  still  a  mentality  falling  short  of 
the  normal.  It  must  be  granted,  however,  that  the  mental 
tests  at  present  available  do  not  serve  to  mark  out  these  higher 
subnormals  with  perfect  accuracy.  Indeed  the  term  "feeble- 
minded" seems  to  have  become  much  too  strong  a  term  to  use 
of  many  persons  whom  we  can  still  put  down  as  clearly  sub- 
normal. It  may  be  well  enough  to  term  imbeciles  and  idiots 
simply  more  and  more  pronounced  examples  of  feeble-minded- 
ness. It  is,  however,  a  shock  to  the  layman's  mind  to  hear 
persons  of  but  slightly  substandard  mentality  termed  feeble- 
minded. Indeed,  when  we  examine  the  brains  of  these  sub- 
normal persons,  post  mortem,  we  find  that  they  are  in  general 
appearance  but   slightly,   if  at  all,   removed   from   normality, 

463 


464  THE    KINGDOM    OF    EVILS 

When  we  perceive  normal-looking  brains  in  subnormal  persons 
(even  in  morons  we  are  apt  to  find  brams  that  are  not  strik- 
ingly abnormal  in  the  gross)  we  are  likely  to  think  that,  by  a 
slight  twist  of  the  wheel  of  fortune,  such  substandard  persons 
might  possibly  be  made  proper  inhabitants  of  the  world,  proper 
voters,  and  even  proper  parents.  Perhaps  a  slight  variation 
of  the  glands  of  internal  secretion  might  serve  to  turn  the  scale ! 
Or  the  trick  might  be  accomplished,  we  are  apt  to  think,  by  a 
little  more  intensive  education !  Meantime  it  is  almost  or  quite 
impossible  to  draw  a  line  between  those  subaverage  subjects 
that  go  to  make  up  the  group  of  normals  from  these  substand- 
ard persons  that  we  are  willing  to  term  definitely  subnormal. 
The  social  worker  remains  as  much  at  a  loss  as  does  the  psy- 
chologist. Lawyers  and  even  judges  flounder  in  a  morass  of 
doubt  when  it  comes  to  calling  these  but  slightly  substandard 
subjects  "feeble-minded." 

Is  there  a  group  of  (as  it  were)  superfeehle-minded  above 
the  group  of  the  feeble-minded  proper  (morons)  and  far 
above  the  imbeciles  and  idiots?  The  senior  author  of  this 
work  has  sometimes  argued  for  a  new  term  to  cover  all  the 
forms  of  feeble-mindedness,  including  the  unnamed  slight  de- 
gree of  subnormality  that  lies  above  the  so-called  moronity. 
The  term  chosen  was  hypo  phrenic  and  the  condition  of  feeble- 
mindedness of  whatever  degree  may  be  known  as  hypophrenia. 
We  believe  that,  if  the  layman,  lawyer,  or  judge  feels  quite 
smcerely  averse  to  calling  certain  persons  "feeble-minded," 
particularly  persons  in  this  subnormal  group  above  the  level 
of  moronity,  he  ought  to  be  far  more  willing  to  have  the  term 
"hypophrenic"  used.  Moreover  in  our  public  discussion  of 
these  cases  (particularly  in  the  presence  of  the  patients  them- 
selves), would  it  not  be  highly  convenient  to  be  able  to  use  the 
term  hypophrenic,  a  term  which  is  of  unknown  insignificance 
to  the  patient  himself.  When  a  patient  who  is  slightly  sub- 
normal and  perhaps  (as  often)  is  rather  acutely  conscious  of 
his  subnormality,  hears  himself  dubbed  "feeble-minded,"  he 
has  a  certain  right  to  feel  nettled.  We  feel  that  the  employ- 
ment of  the  term  feeble-minded,  even  for  morons  of  the  upper 
grade  and  certainly  for  the  subnormals  that  are  above  the  level 
of  morons,  sometimes  makes  a  kind  of  permanent  scar  in  the 
patient's  mind.  We  have  also  seen  persons,  who  upon  dis- 
covering  themselves   to   be   "feeble-minded,"   have    forthwith 


THE    KINGDOM    OF    EVILS  465 

denied  all  responsibility  for  any  acts  of  theirs  and  given  them- 
selves serenely  up  to  behavior  which  they  could  very  readily 
and  profitably  restrain.  It  is  all  very  well  to  be,  as  Dr.  Richard 
Cabot  has  often  insisted,  belligerent  in  truth-seeking  and  in 
telling  the  truth,  but  if  we  employ  the  term  feeble-minded  in 
a  very  extended  sense,  not  consistent  with  the  lay  usage  of  the 
adjective  feeble,  we  are  not  telling  the  whole  truth  about  our 
patients.  It  is  worth  while  to  insist  upon  this  little  point  since 
so  much  important  psychiatric  social  work  has  to  be  carried 
out  with  persons  that  are  feeble-minded. 

Feeble-mindedness  is  of  interest  to  a  great  number  of  work- 
ers in  the  world.  For  example,  (a)  educators,  responsible  for 
the  laggards,  truants,  dullards,  "exceptionals" ;  (b)  court  au- 
thorities to  whom  the  educators'  problems  in  part  drift  and 
figure  as  psychopathic  cases,  defective  delinquents,  prostitutes, 
and  the  like;  (c)  eugenists  and  other  persons  interested  in 
heredity  who  are  inclined  to  advocate  segregation  in  institu- 
tions or  perhaps  even  sterilization  of  the  feeble-minded  on  the 
basis  that  the  entire  problem  is  a  hereditary  one;  (d)  legisla- 
tors, to  whom  of  late  feeble-mindedness  has  become  the  most 
interesting  of  social  problems. 

Under  the  case  of  Florence  Warner  (case  47)  we  have 
spoken  of  conditions  under  which  mental  tests  must  be  carried 
out  (absence  of  fatigue  on  the  part  of  the  examiner  and  pa- 
tient; absence  of  all  clouding  of  consciousness,  such  as  infec- 
tious disease,  alcohol,  drugs,  and  the  like  may  produce ;  and  the 
absence  of  all  stupor  or  dullness  of  mental  faculties  incident 
to  mental  diseases  like  dementia  praecox). 

Florence  Warner  illustrates  the  relations  of  feeble-minded- 
ness to  prostitution  or  at  all  events  to  sex  irregularity.  The 
White  Slave  Traffic  Commission  of  the  Commonwealth  of 
Massachusetts  did  indeed  find  that  about  one-half  of  the  pros- 
titutes examined  for  their  mental  levels  turned  out  to  be  in 
some  degree  feeble-minded.  But,  even  if  all  or  almost  all 
prostitutes  were  feeble-minded,  it  does  not  do  for  the  social 
worker  to  think  of  all  feeble-mindedness  in  women  as  fatally 
determining  irregular  sex  life.  Further  investigations  of  the 
lives  of  feeble-minded  persons  released  from  schools  for  the 
feeble-minded,  after  their  schooling  has  been  completed,  has 
shown  that  many  frankly  feeble-minded  persons,  even  of  the 
female  sex,  have  not  fallen  into  the  group  of  sex  delinquents, 


466  THE    KINGDOM    OF    EVILS 

Even  when  feeble-mindedness  is  present  in  the  sex  dehnquent 
it  is  not  always  possible  to  assign  prostitution  to  feeble-minded- 
ness as  a  cause.  The  most  we  can  say  in  this  contingency  is 
that  a  feeble-minded  person  whose  sex  irregularities  may  be 
due  to  something  quite  other  than  feeble-mindedness  may  still 
be  tmable  to  react  zvith  proper  judgment  to  the  measures  taken 
to  stop  the  sex  irregularity  and  to  divert  the  patient's  interest. 

We  may  also  refer  to  the  discussions  under  case  47  of  the 
differential  values  of  the  psychiatrist,  the  psychologist,  and  the 
social  worker  in  the  handling  of  feeble-mindedness. 

The  case  of  Bessie  Newman  (case  48)  will  be  remembered 
as  a  very  striking  family  case  in  which  it  was  psychologically 
desirable  to  consider  every  one  of  the  ten  members  of  the 
family  from  the  psychiatric  point  of  view.  Amongst  all  the 
cases  of  this  work  that  of  Bessie  Newman  is  the  one  which 
will  perhaps  most  repay  study.  The  Rosenthal  family  (case 
49)  has  also  shown  that  three  out  of  five  of  its  members  are 
psychopathic.  The  case  of  Bernard  Bornstein  (case  50) 
shows  how  a  moron  boy  in  a  protected  environment  could  be 
the  support  of  his  family;  whereas  navy  life  proved  to  be 
beyond  his  powers. 

Beatrice  Cellini  (case  52)  was  handled  as  an  out-patient 
under  the  social  service  without  ever  being  in  the  wards  of  the 
Psychopathic  Hospital.  Reference  may  be  made  to  the  remarks 
under  the  discussion  of  Beatrice  Cellini  concerning  variations 
in  her  moods. 


EPILEPTOSES 

Syphilitic  Symptomatic 

Alcoholic  Idiopathic 

Traumatic  Psychic 

Encephalopathic  Narcoleptic 

Jacksonian  Borderland 


EPILEPSIES 

Epilepsy  (Group  III  of  Book  III)  is  ordinarily  a  disease 
with  at  least  (a)  unconsciousness  and  (b)  convulsions.  An 
attack  of  unconsciousness  alone  does  not  constitute  epilepsy 
and  does  not  in  itself  prove  the  existence  of  epilepsy.  Neither 
would  a  single  convulsion,  even  though  it  were  very  character- 
istic in  its  appearance,  prove  the  existence  of  epilepsy.  If, 
however,  the  diagnosis  of  epilepsy  is  once  established  through 
medical  observation  of  several  attacks  of  unconsciousness  with 
convulsions,  then  it  becomes  possible  for  the  physician  to  iden- 
tify certain  minor  attacks  and  disorders  of  consciousness  with 
little  or  no  evidence  of  convulsions,  as  epileptic.  Accordingly 
when  fainting  spells,  abstraction,  blank  feelings,  and  episodes 
of  loss  of  memory  occur,  the  physician  is  very  apt  to  think 
of  the  possibility  of  epilepsy. 

Modern  work  seems  to  have  shown  that  there  is  an  epileptic 
temperament  or  personality  in  which  self -consciousness  (ego- 
centricity)  and  inharmony  and  irritability  are  found.  The 
epileptic  mind  seems,  on  the  whole,  a  little  childlike,  even  when 
there-  is  little  proof  of  feeble-mindedness.  Modern  study  of 
epilepsy  has  shown  that  it  is  much  more  exact  to  speak  of 
epilepsies  than  of  epilepsy. 

The  major  or  so-called  grand  mal  attack  of  epilepsy  con- 
sists in  a  fall  with  unconsciousness  and  spasm.  The  spasm 
is  at  first  a  steady  tonic  spasm,  but  there  shortly  appear  inter- 
rupted or  clonic  spasms.  Automatic  movements  follow  these 
clonic  spasms.  The  patient  then  either  wakes  up  or  passes 
into  a  deep  sleep.  On  waking  the  victim  feels  lame  and  weak 
in  the  convulsed  muscles,  and  his  head  may  ache.  There  is 
often  absolutely  no  warning  of  these  attacks  though  very 
striking  warnings  or  so-called  aiirae  (such  as  flashes  of  light, 
sounds,  or  smells)  may  occur  and  as  a  rule  always  in  exactly 
the  same  form.  The  muscles  are  apt  to  be  affected,  always  in 
the  same  order,  and  the  convulsion  is  then  said  to  "march"  in 
a  characteristic  way.  Tongue-biting  and  frothing  at  the  mouth 
are  observed,  and  the  patient  may  involuntarily  urinate.    It  can 

469 


470  THE    KINGDOM    OF    EVILS 

readily  be  seen  that  the  social  worker  who  secures  the  history 
of  tongue-biting  or  urination  in  an  attack  of  epilepsy  may  be 
contributing  most  important  evidence  for  medical  diagnosis. 

It  seems  to  have  been  proved  that  the  epileptic  attack  of  the 
nature  above  described  may  sometimes  be  represented  by  an 
acute  mental  attack  without  convulsion  and  even  without  evi- 
dent loss  of  consciousness.  Such  an  attack  without  characteris- 
tic features  of  epilepsy  is  termed  an  epileptiform  equivalent. 
The  patient  may  fall  into  a  state  of  automatism  or  into  a  dream- 
state  in  which  violent  and  destructive  or  criminal  acts  get  done, 
of  which  the  patient  will  have  no  remembrance.  The  crimes  of 
violence  commited  by  epileptics  may  be  of  the  greatest  brutality 
(see  our  case  54,  Patrick  Donovan,  who  killed  his  mother). 
Luigi  Silva  (case  53)  had  also  been  violent  and  destructive 
during  a  fit.  The  episode  in  Silva's  case  followed  a  heavy 
drinking  bout.  Alcohol  is  clinically  known  to  bring  out  epilep- 
tic attacks. 

MENTAL   DISEASES    CAUSED    BY    ALCOHOL   AND    DRUGS 

In  our  account  of  the  pharmacopsychoses,  that  is,  the  mental 
diseases  due  to  alcohol  and  drugs  (Group  IV  of  Book  III), 
we  have  presented  five  cases,  four  alcoholic  and  one  drug 
(Marian  Spring,  case  63). 

The  four  alcoholic  cases  are  intended  to  exemplify  the  four 
forms  of  alcoholic  mental  disease  that  come  to  the  attention 
of  the  social  worker.  John  Logan  (case  58)  is  a  case  of  acute 
alcoholism.  We  may  remind  the  lay  reader  that  acute  alcohol- 
ism is  not  identical  with  acute  alcoholic  psychosis.  Of 
course  it  is  true  in  one  sense  that  drunkenness  is  a  temporary 
mental  disorder,  but  drunkenness  is  not  a  disease  in  the  sense 
of  an  entity  with  a  characteristic  onset,  course,  and  duration. 
Drunkenness  is  not  commonly  accounted  a  mental  disease. 
Acute  alcoholism  is  a  term  frequently  used  to  cover  drunken- 
ness and  other  comparatively  mild  mental  effects  of  alcoholism, 
falling  short  of  our  conception  of  mental  disease.  Chronic 
alcoholism  is  a  term  used  to  describe  a  habit  of  drinking  which, 
though  it  may  be  the  basis  of  a  development  of  mental  dis- 
order, is  also  not  in  itself  a  mental  disease.  Drunkenness  and 
alcoholism,  acute  or  chronic,  are  conditions,  according  to  pres- 
ent usage,  outside  the  field  of  mental  diseases. 


THE    KINGDOM    OF    EVILS  471 

Patrick  Nolan  (case  59)  is  a  case  of  delirium  tremens 
which  may  be  compared  in  its  symptoms  with  the  case  of  John 
Sullivan  (case  60)  an  instance  of  so-called  alcoholic  hallucin- 
osis. Delirium  tremens,  the  better  known  and  somewhat  com- 
moner of  these  two  affections,  is  a  comparatively  brief  disease 
whose  acute  symptoms  commonly  do  not  run  beyond  a  week 
in  duration.  Alcoholic  hallucinosis,  on  the  other  hand,  is  apt 
to  run  two  or  more  weeks.  Neither  delirium  tremens  nor  alco- 
holic hallucinosis  depends  for  its  severity  upon  the  amount  of 
alcohol  consumed.  Both  diseases,  as  a  rule,  appear  in  persons 
who  have  long  been  victims  of  alcoholism.  (Here  again  it  is 
impossible  to  assert  that  the  severity  of  a  mental  disease  can 
be  measured  by  the  duration  or  extent  of  the  alcoholic  habit.) 

The  distinction  between  these  two  diseases  is  even  to  the 
physician  far  less  easy  in  practice  than  in  theory.  The  most 
striking  mental  difference  in  the  two  diseases  is  the  presence 
of  hallucinations  of  sight  in  delirium  tremens  and  hallucina- 
tions of  hearing  in  alcoholic  hallucinosis.  Yet  even  this  dis- 
tinction may  fail  us  in  certain  cases.  The  name  delirium  tre- 
mens in  itself  points  to  the  extreme  severity  of  the  symptoms, 
that  is  to  the  existence  of  (a)  delirium  and  of  (b)  tremors, 
and  the  victim  of  delirium  tremens  is,  on  the  whole,  a  much 
sicker-looking  man  than  the  victim  of  alcoholic  hallucinosis. 
Of  the  two  diseases,  alcoholic  hallucinosis  is  ordinarily  the 
worse  one,  since  the  capricious  scolding  voices  readily  lead  to 
suspiciousness  and  delusions  of  persecution  that  may  outlast 
the  pronounced  mental  symptoms  and  reach  into  the  convales- 
cent life  of  the  patient.  In  fact  some  of  these  latter  cases  dur- 
ing their  state  of  recovery  and  for  long  periods  after  the  acute 
symptoms  are  over,  very  strikingly  resemble  victims  of  de- 
mentia praecox.  Moreover  cases  of  alcoholic  hallucinosis  are 
not  apt  to  get  well  so  frequently  or  so  completely  as  victims  of 
delirium  tremens. 

Michael  Piso  (case  62)  we  have  used  to  represent  the  so- 
called  alcoholic  jealousy-psychosis.  The  theory  here  seems 
to  be  that  long-continued  alcoholism  has  reduced  the  sexual 
power  of  its  victim,  who  then  becomes  jealous  of  the  relations 
of  the  spouse  to  some  supposed  paramour.  The  case  in  the 
text  shows  a  comparatively  happy  outcome  through  medical 
and  social  effort. 

Our  case  of  morphinism,  Marian  Spring  (case  63)  is,  no 


472  THE    KINGDOM    OF    EVILS 

doubt,  an  example  of  the  so-called  psychopathic  personality,  as 
are  many  victims  of  morphinism  and  cocainism.  We  count  the 
case  as  a  social-service  failure,  but  the  details  (note  especially 
the  patient's  lying)  are  of  interest.  Marian  Spring  also  illus- 
trates the  tendency  of  morphinists  and  other  drug  addicts  to 
work  in  groups. 

That  the  reader  may  obtain  some  inkling  of  the  conditions 
in  certain  other  major  groups  of  mental  disease,  we  present  in 
cases  63-68  two  instances  each  of  mental  disease  due  to  de- 
structive disease  of  the  brain,  the  disease  of  the  eye  indirectly 
affecting  the  mind,  and  to  certain  complications  of  old  age. 

BRAIN  DISEASE 

It  is  plain  that  destructive  disease  of  the  brain  (Group  V  of 
Book  III)  will,  as  a  rule,  send  its  victim  pretty  promptly  to 
some  hospital  for  nervous  or  jnental  disease,  leaving  the  fam- 
ily problem  a  comparatively  simple  one,  not  as  a  rule  troubled 
by  any  special  mental  feature  on  the  part  of  the  patient  him- 
self. The  group,  a  fairly  small  one  in  this  line  of  practice,  is 
of  no  great  statistical  consequence  to  social  workers. 

BODILY  DISEASE 

As  to  mental  disease  due  to  diseases  of  the  body  at  large 
(Group  VI  of  Book  III)  such  as  diseases  of  the  glands  of 
internal  secretion,  typhoid  fever,  pneumonia,  influenza,  pellagra, 
and  the  like,  there  are  on  the  whole  very  few  cases,  statistically 
speaking,  and  still  fewer  that  come  under  the  social  worker's 
care.  An  exception  would  need  to  be  made  for  pellagra  in  the 
southern  states  and  no  doubt  an  important  piece  of  social 
research  could  be  carried  out  upon  the  pellagra  situation  in  the 
southern  states.  Most  important  data  concerning  the  culinary 
and  sanitary  relations  of  pellagra  could  be  made  by  social 
workers. 

We  have  chosen  to  illustrate  this  group  by  a  case  of  hyper- 
thyroidism, Ethel  Murphy  (case  66)  and  one  of  mental  dis- 
ease due  to  influenza,  Joseph  O'Brien  (case  67). 

OLD  AGE 

Problems  of  great  interest  are  associated  with  social  work 
amongst  seniles  (Group  VII  of  Book  III).     Of  course  it  is 


THE    KINGDOM    OF    EVILS  473 

well  known  that  not  all  old  persons  pass  into  anything  like  a 
condition  of  dementia  or  evident  deterioration.  Some  authors, 
it  is  true,  speak  of  a  physiological  dementia  (  ?)  and  seem  to 
think  of  old  age  as  capable  of  producing  mental  disease  or  at 
least  dementia.  We  must  guard  ourselves  against  generalizing 
in  this  way.  We  have  chosen  two  cases  which  ordinarily  would 
seem  a  bit  hopeless  from  the  standpoint  of  social  work  but 
which  proved  very  amenable  to  social-service  methods.  We  are 
under  the  impression  that  the  psychiatric  point  of  view,  if  it 
should  penetrate  to  the  homes  for  aged  persons  and  old  sol- 
diers, might  prove  of  singular  value  in  the  handling  of  con- 
crete problems  of  senescence. 

DEMENTIA  PRAECOX 

The  schizophrenic  cases — dementia  praecox  (Group  VII  of 
Book  III),  form  a  large  and  important  group  in  the  field  of 
psychiatry.  Beginning  most  frequently  during  adolescence  or 
early  adult  life  and  having  a  very  grave  prognosis,  schizo- 
phrenia affords  many  distressing  social  situations.  This  psy- 
chosis has  two  main  characteristics :  (a)  a  splitting  of  the  per- 
sonality (schizophrenia)  and  (&)  a  tendency  to  deterioration. 
"Splitting"  means  that  there  is  no  longer  a  congruity  between 
the  three  psychological  elements  that  form  the  personality; 
namely,  the  intellect,  the  affective  reactions,  and  the  will.  The 
result  is  emotional  apathy,  loss  of  interest  in  one's  family,  lack 
of  normal  activity,  inability  to  carry  out  one's  purpose.  The 
majority  of  persons  afflicted  with  this  form  of  disease  develop 
ideas  of  persecution,  believe  they  are  being  followed,  interfered 
with,  not  given  a  square  deal,  and  the  like.  Hallucinations 
are  apt  to  be  prominent.  These  disorders  associated  with  a 
general  psychic  decrepitude  may  necessitate  commitment  in  an 
institution  for  the  insane.  When  the  disease  remains  chronic, 
the  patient  may  continue  in  an  institution  for  the  remainder 
of  his  life.  The  social  procedures  in  the  chronic  committed 
cases  are  relatively  simple.  It  is  not,  however,  correct  to  as- 
sume that  no  case  recovers.  Many  patients  with  dementia 
praecox  make  fair  recoveries  and  are  able  to  live  in  the  com- 
munity. Often  the  defect  resulting  from  the  disease  is  mild 
in  degree.  Even  so,  these  patients  need  guidance  and  aid,  and 
most  of  them  require  some  form  of  social  assistance. 


474  THE    KINGDOM    OF    EVILS 

The  schizophrenic  group  is  brought  to  the  attention  of  the 
social  worker  chiefly,  during  the  early  or  incipient  period  of  the 
disease.  For  months  and  often  for  years  before  a  patient  has 
the  outstanding  symptoms  of  a  psychosis,  mental  peculiarities, 
character  anomalies,  unusual  actions,  and  maladjustments  lead 
to  observation  by  social  agencies.  Unless  an  astute  psychiatrist 
sees  the  patient  in  this  early  state,  the  person  is  likely  to  be 
considered  as  stubborn,  unreliable,  delinquent,  obtuse,  peculiar, 
or  lazy,  rather  than  ill  and  a  proper  subject  for  understanding, 
sympathy,  and  help.  Many  are  the  difficulties,  delinquencies, 
and  misfortunes  due  to  early  symptoms  of  the  disease. 

Despite  the  relative  impossibility  of  affecting  cures  in  the 
disease  with  our  present  knowledge,  it  is  surprising  how  much 
may  often  be  accomplished  to  improve  the  social  reactions  of 
these  patients  by  proper  social  adjustments.  Unfortunately 
much  useless  effort  is  expended  by  social  workers  in  attempts 
to  aid  such  persons  before  their  disease  has  been  diagnosed. 

The  symptoms  which  may  be  manifested  by  schizophrenia 
patients  are  numerous  and  varied.  In  fact,  Kraepelin,  in  his 
latest  classifications,  considers  seven  varieties  of  dementia 
praecox  and  the  closely  allied  paraphrenias.  It  is  obviously  not 
desirable  to  present  the  medical  points  of  this  complex  disease 
except  in  a  medical  treatise.  It  may  be  noted  that  the  symp- 
toms result  in  peculiarities  in  the  patients  that  lead  to  a  lack 
of  "empathy." 

Medical  science  has  not  solved  the  major  problems  of 
schizophrenia,  i.e.,  etiolog}^  and  pathology.  As  a  corollary  no 
specific  treatment  is  known.  Every  case  must  be  carefully 
considered,  however,  from  the  purely  medical  side  for  evi- 
dences of  endocrine  disorder,  organic  disease,  and  metabolic 
disorder,  as  well  as  for  psychological  factors  in  the  life  of  the 
patient.  Life  experience  and  environmental  conditions  play 
an  important  role  in  the  development  of  the  psychosis.  So  the 
social  worker  may  have  a  function  in  prevention  and  treatment 
as  well  as  in  social  adjustment. 

It  is  important  to  place  schizophrenic  patients  under  care 
at  the  earliest  possible  moment ;  as  it  is  with  any  person  devel- 
oping a  disease,  acute  or  chronic.  Many  schizophrenics  show 
character  anomalies  from  early  childhood  that  are  suggestive. 
Among  these  traits  may  be  mentioned  "shut  in"  personality, 
inability  to  make  friends  and  take  part  in  communal  activities 


'THE  "KINGDOM  -DF   EVILS  475 

"with  zest,  supef sensitiveness,  over-conscientiousness,  egocen- 
tricity,  metaphysical  ruminations,  obstinacy,  phantasy- forma- 
tion, or  day-dreaming.  These  characteristics  cause  such  per- 
sons to  be  considered  peculiar,  eccentric,  exceptional,  or 
difficult;  whereas  they  should  indicate  a  careful  psychiatric 
examination. 

Some  of  the  problems  of  schizophrenia  are  presented  in 
twelve  cases  of  Book  III,  cases  70-81.  Dana  Scott  (case  70) 
is  a  case  of  the  simplex  form,  a  type  that  is  often  undiagnosed. 
This  type  of  schizophrenia  is  seldom  seen  in  the  institutions 
for  the  chronic  insane,  the  victims  usually  remaining  in  the 
community,  presenting  difficulties  to  society  and  finding  life 
a  serious  problem.  Proper  environmental  treatment  met  with 
relative  success  in  the  case  of  Scott. 

Ralph  Johnson  (case  71)  is  another  patient  who  presented 
numerous  problems  to  society,  which  arose,  presumably,  as  a 
result  of  his  mental  state,  diagnosed  as  dementia  praecox. 
Wanderlust,  alcoholism,  idleness  and  poverty,  hypochondria, 
hallucinations  and  delusions,  punctuated  the  life  history  of  this 
man.  Improvement  in  his  attitude  and  conduct  was  shown 
after  the  combination  of  medical  and  social  treatment.  Per- 
sons with  this  type  of  mental  disease  are  familiar  to  social 
agencies  as  prostitutes,  tramps,  almshouse  habitues,  and 
dependents. 

Paraphrenia  is  a  diagnosis  applied  to  cases  akin  to  dementia 
praecox,  but  showing  less  dissociation  of  the  personality  and  a 
slower  progress  toward  deterioration.  These  cases  are  rela- 
tively rare  and  present  problems  similar  to  the  dementia  prae- 
cox cases.  In  fact,  the  paraphrenias  are  described  in  a  sub- 
heading under  the  schizophrenic  group.  Manual  Rizzo  (case 
72)  is  presented  as  an  illustration  of  this  type  of  disease,  diag- 
nosed paraphrenia  systematica.     (See  also  case  58.) 

The  case  of  Paul  Ernst  (case  73)  emphasized  the  difficulty 
in  the  dififerentiation  of  schizophrenia  (dementia  praecox)  and 
cyclothymia  (manic-depressive  psychosis)  and  offers  a  good 
lesson  in  the  value  of  optimism.  Hasty  conclusions  may  lead 
one  to  a  pessimistic  inactivity  in  cases  called  dementia  praecox. 
It  is  well  to  suspect  the  worst  but  to  act  on  the  optimistic  as- 
sumption that  effort  will  be  repaid.    It  was  so  in  this  case. 

The  "spoiled  child"  should  always  make  one  suspicious  of 
the  possibility  of  a  future  psychosis.     Nora  McCarthy   (case 


476  THE    KINGDOM    OF    EVILS 

74)  was  considered  a  spoiled  child.  Her  later  reactions  led  to 
a  psychiatric  diagnosis  of  dementia  praecox.  However,  with  a 
comparatively  small  amount  of  assistance,  she  learned  to  get  on 
fairly  well. 

The  usual  mistake,  especially  outside  of  psychiatric  clinics, 
is  not  that  of  making  too  serious  a  diagnosis  and  prognosis, 
as  might  be  assumed  to  have  been  the  case  with  Nora  McCar- 
thy (case  74)  but,  on  the  other  hand,  the  tendency  is  to  diag- 
nose the  early  stage  of  a  mental  disease  as  psychoneurosis.  A 
large  number  of  schizophrenias  are  at  first  considered  psycho- 
neuroses.  Clara  Goldberg  (case  75)  received  much  attention 
under  the  diagnosis  of  psychoneurosis,  but  after  three  years 
of  unsuccessful  efforts  at  social  adjustment  the  diagnosis  was 
changed  to  dementia  praecox,  and  she  was  put  under  the  care 
of  a  state  hospital. 

George  Stone  (case  76)  calls  attention  to  the  difficulty  of 
deciding  whether  a  paranoid  individual  should  be  committed. 
At  times  such  patients  are  able  to  get  on  fairly  well  in  the  com- 
munity under  supervision.  Stone  was  unable  to  get  along, 
however,  and  had  to  be  committed.  George  Mullen  (case  jy^ 
on  the  other  hand,  was  able  to  serve  in  the  front  lines  of  the 
British  Army  after  a  five  months'  stay  in  a  state  hospital.  His 
improvement  proved  to  be  but  temporary,  and  he  had  to  be 
committed  again  after  his  discharge  from  the  army. 

Paul  Dawson  (case  78)  had  been  a  problem  from  early  life. 
At  the  Mexican  border  he  "broke"  and  received  a  diagnosis 
of  dementia  praecox  with  his  discharge.  He  then  became  a 
"difficult  case"  for  his  family.  Drafted  into  the  army,  he  was 
again  discharged  with  the  label  dementia  praecox.  He  claimed 
to  have  "faked"  mental  disease  to  get  out  of  the  army.  Experi- 
ence has  taught  that  most  malingerers  are  psychopaths  and 
likely  to  become  definitely  psychotic.  Dawson  was  considered 
a  real  case  of  dementia  praecox.  Nevertheless  he  made  good  in 
the  merchant  marine.  It  is  a  question  how  long  he  will  remain 
well. 

Howard  Lancaster  (case  79.)  seems  to  show  that  environ- 
ment is  an  important  factor  in  the  development  of  mental 
disease.  Under  civilian  conditions  he  did  well  but  became  ill 
in  the  military  service,  recovering  when  again  placed  under  the 
conditions  of  civil  life. 

The  relationship  of  psychiatry  and  criminology  is  depicted 


THE    KINGDOM    OF    EVILS  477 

by  Major  Dobson  (Captain  Hill,  case  80),  whose  dementia 
praecox  symptoms  took,  in  one  instance,  the  form  of  forgery. 
His  marriage  may  also  be  considered  as  having  a  psychopatho- 
logical  basis.  It  may  be  assumed  that  many  of  his  past  ad- 
ventures and  his  instability  were  forerunners  of  more  overt 
symptoms. 

MANIC-DEPRESSIVE  PSYCHOSES 

In  many  ways  the  cyclothymic  group — manic-depressive  psy- 
chosis (Group  IX  of  Book  III),  offers  more  of  interest  to  the 
psychiatrist  and  psychiatric  social  worker  than  any  other  group 
of  cases.  The  mental  disorder  called  cyclothymia  is  character- 
ized by  occasional  attacks  with  remissions,  or  intervals  of  good 
health.  The  attacks  usually  vary  from  a  few  days  or  weeks  to 
a  year  or  more,  while  the  remissions  may  last  for  years  or 
decades,  or  the  disease  may  be  limited  to  one  attack.  The 
severity  of  the  symptoms  likewise  varies  from  very  mild  emo- 
tional changes  to  the  severest  types  of  mania  and  depression. 
The  disease  is  chiefly  an  affective  one,  causing  pathological 
exaggeration  of  the  emotions.  Depression,  with  feelings  of 
insufficiency,  self-accusatory  ideas,  difficulty  in  thinking,  and 
general  slowing  up  of  mental  and  physical  activity  are  present 
fn  the  depressive  stage  of  the  disease.  In  direct  contrast  to 
this  are  the  symptoms  of  the  maniacal  phase,  feeling  of  well- 
being,  self-appreciation,  exaggerated  ideas  of  one's  own  power, 
and  mental  and  physical  activity.  In  the  so-called  mixed 
phases  of  the  disease  a  combination  of  the  symptoms  of  depres- 
sion and  mania  exist.  Most  of  the  symptoms  are  easily  under- 
stood by  a  second  person,  because  they  are  exaggerations  of  the 
normal  feelings  rather  than  new  or  "different"  or  "peculiar" 
reactions.  Hence  it  can  be  said  that  one's  "empathic  index" 
is  usually  high  toward  such  patients. 

Cyclothymic  patients  do  not  deteriorate.  No  matter  how 
severe  the  symptoms,  how  long  the  attack  lasts,  or  how  fre- 
quent the  attacks  may  be,  there  is  no  resultant  dementia.  And 
as  may  be  expected  if  this  statement  is  true  there  is  no  patho- 
logical destructive  brain  lesion. 

The  hospital  for  mental  patients  is  only  a  temporary  refuge 
for  the  cyclothymic,  if  such  hospital  care  becomes  necessary  at 
all.  Winifred  Reed  (case  81)  spent  but  a  few  days  in  the  hos- 
pital   for   purposes    of    diagnosis    during   the   first   seventeen 


478  THE    KINGDOM    OF    EVILS 

months  of  her  acquaintance  with  the  Psychopathic  Hospital, 
and  WilHam  Donahue  (case  82)  has  never  been  an  inmate  of 
an  institution  for  his  mental  diseases.  Mild  attacks  of  excite- 
ment or  depression  are  frequently  not  diagnosed,  and  in  the 
absence  of  proper  diagnosis  the  patient  may  be  entirely  mis- 
understood and  wrongly  handled.  When  one  correctly  under- 
stands Winifred's  eroticism  as  a  symptom  of  the  maniacal 
stage  of  a  manic-depressive  psychosis  of  only  temporary  dura- 
tion, sympathy  is  evoked  and  proper  treatment  is  available. 
Likewise  one  is  ready  and  able  to  help  Donahue  over  his 
"grouches"  and  spells  of  "lost  initiative"  on  the  ground  of 
treating  a  depressed  patient. 

Marie  Dubois  (case  83)  is  presented  as  a  case  of  manic- 
depressive  psychosis,  having  a  first  attack  at  thirty  years  of 
age  and  a  second  at  forty.  The  first  attack  was  one  of  de- 
pression, the  second  beginning  with  depression  went  over 
into  a  mild  excitement  before  recovery.  Such  a  sequence  is 
by  no  means  rare.  Her  return  to  the  community  after  a  fairly 
severe  attack  of  mental  disease  brings  into  prominence  the 
problem  of  the  complete  readjustment  that  is  necessitated. 
Such  a  patient  must  again  take  her  place  in  a  community  all 
too  ready  to  be  suspicious  of  anyone  who  has  been  "insane." 
Friends  who  comprehend  the  situation  and  who  can  aid  are 
quite  essential.  The  family,  even  if  possessed  of  sufficient 
means,  are  rarely  capable  of  offering  intelligent  aid.  Here 
the  psychiatric  social  worker  is  invaluable. 

Hypomania  falls  in  the  group  of  cyclothymias.  It  is  a  very 
mild  degree  of  mania.  Joe  Marino  (case  84)  developed  this 
condition  when  but  fifteen  years  of  age.  Difficulty  after  diffi- 
culty resulted  from  his  overactivity.  His  activities  were  rather 
typical  of  the  hypomanic — frequent  changes  of  position  and 
actions  that  led  to  arrest  punctuated  his  useful  career.  The 
hyperactivity  in  Joe,  as  is  typical  in  cases  of  hypomania,  lasted 
a  comparatively  short  period,  and  then  he  settled  down.  Dur- 
ing the  period  of  excitement,  however,  he  was  a  very  difficult 
problem,  and,  as  during  a  large  portion  of  his  disease  he  was 
able  to  live  outside  of  the  hospital,  one  can  see  the  great  need 
for  some  oversight  in  order  to  steady  him. 

Robert  MacPherson  (case  85)  is  another  example  of  the 
hypomanic  condition.  When  the  excitement  is  mild  enough, 
the  overactivity  that  is  characteristic  of  this  state  may  lead  to 


THE    KINGDOM    OF    EVILS  479 

useful  accomplishments.  This,  of  course,  is  not  the  rule,  but 
at  times  patients  are  seen  who  are  more  successful  during  this 
period  because  of  the  lessened  inhibitions.  They  may  be  more 
capable  as  salesmen.  They  execute  their  ideas  without  further 
thought.  MacPherson  made  more  money  during  his  hypo- 
manic  state  than  he  would  have  made  had  he  been  normal. 
However,  he  squandered  it  with  great  abandon.  Frequently 
patients  in  this  condition,  as  well  as  patients  in  the  early  stage 
of  general  paresis,  will  squander  their  possessions  and  run  up 
debts,  as  well  as  spoiling  their  reputations  by  fast  and  lascivi- 
ous living.  From  this  point  of  view,  if  from  no  other,  it  is 
very  important  that  recognition  of  this  condition  be  made 
early,  in  order  that  the  patient  may  be  prevented  from  per- 
forming foolish  and  dangerous  acts. 

Two  main  characteristics  of  the  manic-depressive  psychosis, 
namely,  repeated  attacks  and  complete  recovery,  are  well  illus- 
trated by  the  case  of  Clarence  Adams  (case  86).  For  the 
rest  his  case  shows  the  same  type  of  problem  as  the  two  pre- 
ceding cases. 

A  word  should  perhaps  be  said  about  one  important  social 
complication  of  the  depressive  phase  of  the  manic-depressive 
psychosis.  This  is  the  potentiality  of  suicide.  While  it  is 
quite  possible  to  supervise  maniacal  patients  outside  of  the 
hospital,  despite  their  tendencies  toward  fast  living  and  delin- 
quency, it  is  much  more  dangerous  to  handle  a  depressed  pa- 
tient outside  of  the  hospital.  Although  the  symptoms  may  be 
mild  and  the  patient  quite  willing  to  sit  about  the  house,  and 
so  may  be  easily  cared  for,  it  is  an  exceedingly  risky  matter 
to  leave  the  depressed  patient  at  home  and  in  the  community 
because  of  his  great  tendency  to  suicidal  attempts.  It  is  for 
this  reason  that  one  is  prone  to  advise  hospitalization  for 
the  depressed  case  until  recovery  is  quite  complete. 


METHODS  OF  PSYCHOTHERAPY 

HYPNOSIS 

Verbal  Suggestion 
Fixation 
Fascination 
Various 

SUGGESTION  (WAKING) 

Verbal 

Drug 

Apparatus 

AUTOSUGGESTION 

DISTRACTION 

TERRORISM 

INFLICTION  OF  PAIN 

PERSUASION 

WILL  TRAINING 

OCCUPATION  THERAPY 

ISOLATION 

PSYCHOANALYSIS 


PSYCHONEUROSES 

Various  classifications  have  been  offered  for  the  cases  that 
fall  under  the  general  heading  of  psychoneuroses  (Group  X 
of  Book  III).  A  fairly  generally  accepted  and  workable 
classification  is  that  which  divides  the  psychoneuroses  into 
cases  of  (a)  neurasthenia,  (b)  psychasthenia,  (c)  hysteria, 
and  (d)  anxiety  neuroses.  These  various  cases  were  placed 
together  in  a  group  called  psychoneuroses  on  the  assumption 
that  there  was  no  definite  underlying  organic  pathology  to  ex- 
plain the  symptoms.  The  mental  attitude  or  psychological 
condition  is  supposed  to  have  a  prominent  place  in  the  de- 
velopment of  these  conditions.  The  diagnosis  is  usually  diffi- 
cult. It  must  be  made  only  after  a  careful  physical  examina- 
tion which  rules  out  bodily  disease.  Neurasthenics  are  usually 
considered  by  the  laity  as  imagining  numerous  organic  dis- 
eases. They  feel  tired  and  worn;  complain  of  peculiar  sensa- 
tions in  their  heads  and  inability  to  concentrate;  and  are  apt 
to  fear  many  types  of  disease.  Psychasthenia  may  be  con- 
sidered as  something  of  a  psychological  anomaly.  Under  this 
diagnosis  are  placed  those  people  who  are  known  as  worriers 
and  doubters,  who  have  many  fears  and  obsessions,  who  often 
have  difficulty  in  thinking  clearly  and  logically,  becoming 
"mixed  up"  as  they  often  say.  This  condition  is  usually  pres- 
ent from  early  life,  but  is  subject  to  exacerbation  of  symptoms. 
The  hysterics  are  those  patients  who  present  numerous  symp- 
toms, such  as  paralysis,  blindness,  deafness,  mutism,  convul- 
sions, sensory  disturbances,  in  fact,  almost  any  symptom  with- 
out evidence  of  organic  disease.  The  anxiety  neurosis  is 
characterized  by  a  condition  of  anxious  fear,  which  may  over- 
come the  patient  at  any  time. 

Patients  suffering  from  one  form  or  another  of  the  psycho- 
neuroses are  very  common  at  all  medical  clinics,  and  are 
usually  the  despair  of  the  physicians.  Finally  they  make  their 
way  to  the  psychiatrist,  possibly  after  months  or  years  of 
treatment  in  the  general  clinic;  possibly  after  having  numer- 
ous operations  in  the  attempt  to  relieve  symptoms  which  it 

483 


484  THE    KINGDOM    OF    EVILS 

is  later  believed  were  dependent  upon  a  mental  state  rather 
than  upon  a  visceral  pathology.  Only  in  the  severe  exacerba- 
tions of  their  symptoms  do  these  patients  become  inmates  of 
a  state  hospital  for  the  care  of  mental  cases.  During  a  large 
portion  of  their  disease  they  remain  in  their  homes,  frequent- 
ing physicians'  offices  or  dispensaries.  Occasionally  an  out- 
break of  marked  symptoms  may  lead  to  residence  in  a  state 
hospital.  As  a  rule,  these  attacks  last  only  for  a  short  period, 
and  they  are  not  at  all  frequent.  It  is  more  usual  for  those 
patients  who  can  afford  the  expense  to  go  to  a  sanatorium  for 
treatment  of  a  "nervous  breakdown."  A  modern  psycho- 
pathic hospital  will  treat  numerous  examples  of  these  cases. 

Patients  of  the  psychoneurotic  group  are  patients  par  excel- 
lence for  psychotherapy.  Under  efficient  psychotherapy  must 
be  considered  all  those  factors  that  affect  the  mind  and  life  of 
the  patient.  Among  these  should  be  included  the  patient's 
environment.  It  is  generally  conceded  that  the  experiences  of 
a  person  and  the  conditions  under  which  he  lives  have  much 
to  do  with  the  development  of  a  psychoneurosis.  Therefore 
it  is  logical  that  efforts  to  improve  the  general  environment, 
habits  of  life,  and  living  conditions,  must  have  a  valuable 
place  in  any  psychotherapeutic  treatment.  In  conjunction 
with  whatever  form  of  treatment,  psychotherapeutic  or  or- 
ganic, is  applied  to  the  patient,  the  shaping  of  his  living  con- 
ditions is  very  important,  and  this  work  must  fall,  in  large 
part,  upon  the  social  worker. 

Maurice  Eastman  (case  87)  is  presented  as  a  case  of  neu- 
rasthenia, and  shows  in  a  degree  how  much  can  be  accom- 
plished by  intelligent  social  work. 

Sadie  Strauss  (case  88)  manifests  a  fairly  typical  hysterical 
condition,  and  is  a  good  case  in  point  to  show  the  value  of 
social  work  in  addition  to  formal  psychotherapy.  The  assist- 
ance in  ironing  out  the  family  difficulties  was  certainly  of 
great  value  to  the  psychiatrist  in  aiding  him  to  get  results  by 
his  analysis.  It  is  pointed  out  in  the  case  history  that  the  in- 
formation obtained  by  the  social  worker  of  the  home  conditions 
and  environment  of  Sadie  was  a  valuable  addition  in  giving 
a  rounded  view  of  the  case. 

Joseph  Fangillo  (case  89)  received  the  diagnosis  of  psy- 
chasthenia.  A  hyperconscientious  individual,  prone  to  doubt, 
finding  decisions  difficult,  he  had  upon  such  a  background  at 


THE    KINGDOM    OF    EVILS  485 

least  five  acute  exacerbations  of  symptoms.  From  all  of  these  he 
recovered  fairly  satisfactorily,  but  during  a  large  portion  of 
the  period  of  convalescence  he  lacked  sufficient  force  to  hold 
himself  in  line  without  outside  assistance.  He  had  to  have 
someone  reassure  him.  The  aid  in  obtaining  work  was  very 
important.  The  family  also  had  to  be  assisted  over  the  diffi- 
cult period  of  his  "nervous  breakdown."  Maintaining  the 
family  in  good  condition  was  an  important  aid  in  the  recovery 
of  the  patient. 

Cases  of  traumatic  hysteria,  that  is,  cases  in  which  the  hys- 
terical phenomena  follow  upon  an  accident,  are  always  open 
to  the  suspicion  of  malingering  on  the  part  of  the  patient  in 
order  to  obtain  compensation.  It  is  quite  true  that  in  many 
of  the  cases  improvement  is  delayed  until  the  financial  settle- 
ment is  accomplished,  and  the  physician  handicapped  in  his 
treatment  until  this  matter  is  adjusted.  Something  of  this 
matter  is  brought  out  in  the  case  of  Dennis  O'Donnell  (case 
90)  and  the  question  is  brought  forward  concerning  the  value 
of  social-service  assistance  in  the  case. 

Another  case  of  traumatic  hysteria  is  that  of  Walter  Nelson 
(case  91).  This  man  developing  an  injury  during  his  service 
in  the  Aviation  Corps,  fell  to  the  lot  of  the  social  workers  of 
the  Red  Cross,  and  presents  a  similar  type  of  difficulty  to  that 
of  Dennis  O'Donnell. 

Hysteria  very  frequently  develops  upon  what  is  considered 
as  poor  soil  or  constitutional  inferiority.  The  early  history  of 
Martin  O'Hara  (case  92)  certainly  showed  enough  instability 
to  make  one  consider  him  pretty  poor  material.  Under  army 
conditions  he  apparently  broke  down  with  what  was  consid- 
ered to  be  hysteria.  Upon  discharge  from  the  army,  he  was 
better,  but  after  running  into  a  very  unsuccessful  marital  ex- 
perience, his  symptoms  came  on  again.  This  case  might  be 
used  to  show  the  importance  of  environment  on  the  appearance 
of  symptoms  of  a  hysteric  nature.  Assistance  to  Martin  in 
adjusting  his  life  was  followed  by  improvement  of  symptoms 
and  an  ability  to  care  for  himself  again. 

Another  illustration  of  the  effect  of  environment  on  the 
production  of  psychoneurotic  symptoms  is  brought  forward 
in  the  case  of  Joseph  Levenson  (case  93),  who  developed 
while  in  the  army  symptoms  considered  sufficient  to  make  a 
diagnosis  of  psychasthenia.     Much  social  work  was  expended 


486  THE    KINGDOM    OF    EVILS 

Upon  this  patient  in  attempts  to  find  him  satisfactory  occupa- 
tion, with  a  more  or  less  satisfactory  result. 

Most  of  the  cases  of  the  psychoneurotic  group  must  be  con- 
sidered as  potential  patients  during  a  large  portion  of  their 
lives.  Improvement  and  retrogression  alternate.  Unfavor- 
able conditions  of  life  are  likely  to  lead  to  renewed  difficulties, 
so  that  these  patients  represent  a  fertile  field  for  continued 
work  and  are  likely  to  be  known  to  the  social  agency  year 
after  year.  Nowhere  is  this  service  more  valuable  or  neces- 
sary, and  social  adjustment  is  nearly  always  essential  be- 
fore the  physician  can  get  very  far  with  his  treatment. 

DUBIOUS   AND   SPECIAL   PSYCHOPATHIAS 

The  last  group"  (Group  XI  of  Book  III)  includes  a  pot- 
pourri of  cases  that  fit  in  none  of  the  preceding  ten  groups. 
Among  the  cases  that  would  fall  into  this  group  may  be  men- 
tioned prison  psychosis,  sense  deprivation  psychosis,  folic  a 
deux,  litigation  psychosis,  paranoia,  monomania,  psychopathia 
sexualis,  psychopathic  personality,  and  a  number  of  undiag- 
nosed cases.  Most  of  the  cases  bearing  these  diagnoses  are  not 
legally  committable.  They  are,  rather,  individuals  with  pe- 
culiarities, eccentricities,  and  psychological  anomalies.  Living 
in  the  community  at  large,  as  they  usually  do,  they  are  likely 
to  be  the  victims  of  one  difficulty  after  another.  Their  peculiar 
mental  reactions  are  rarely  compatible  with  success  in  life. 
Social  agencies,  courts,  and  reformatories  are  frequently  con- 
fronted with  the  problems  that  these  persons  present.  Com- 
prehensive understanding  of  these  people  necessitates  a  psy- 
chiatric knowledge  and  insight  into  their  disease  conditions. 

Possibly  the  most  frequent  of  all  these  types  is  that  spoken 
as  the  psychopathic  personality  or  the  constitutional  psycho- 
pathic inferior.  Military  experience  showed  how  numerous 
are  individuals  of  this  type.  Many  of  the  conscientious  ob- 
jectors, malingerers,  and  deserters  fell  into  this  group.  They 
have  in  common  a  personality  defect,  which  usually  works 
against  the  best  advantage  of  the  patient  leading  him  into  a 
continuous  series  of  difficulties. 

Previous  to  the  military  experience,  the  feeling  was  that  the 
vast  majority  of  cases  of  psychopathic  personality  or  consti- 
tutional psychopathic  inferiority  were  of  the  female  sex.     This 


THE    KINGDOM    OF    EVILS  .487 

was  largely  due  no  doubt  to  the  fact  that  it  was  sex  delinquency 
that  brought  many  girls  to  the  attention  of  social  agencies  and 
public  authorities.  The  characterization  of  "defective  delin- 
quent" was  usually  given  to  these  girls,  and  every  social  agency 
was  familiar  with  this  problem. 

A  study  of  defective  delinquency  was  made  by  Dr.  Her- 
man M.  Adler.  Some  of  his  ideas  were  published  in  an  article 
entitled,  A  Psychiatric  Contribution  to  the  Study  of  Delin- 
quency} A  brief  review  of  Dr.  Adler's  paper  will  illuminate 
the  subject.  He  calls  attention,  first,  to  the  six  groups  of 
psychopathic  personalities  described  by  Kraepelin :  the  excit- 
able, the  unstable,  those  with  psychopathic  trend,  the  eccentric, 
the  antisocial  individuals,  and  the  contentious  individuals.  Dr. 
Adler  states : — 

"It  is  clear  that  we  are  dealing  with  a  group  of  individuals 
who  are  so  nearly  normal  that  it  is  only  in  the  course  of  years 
and  by  the  effect  of  cumulative  evidence  that  they  appear  in 
any  way  different  from  the  average. 

"There  are  two  main  factors  to  be  considered.  The  one  is 
the  intelligence  of  the  individual,  his  ability  consciously  and 
logically  to  direct  his  conduct.  The  other  is  the  emotions.  .  .  . 
In  health  the  two  are  well  integrated." 

As  a  result  of  his  experience  with  a  group  o'f  defective  de- 
linquents. Dr.  Adler  believes  that  they  can  be  classified  some- 
what more  simply  than  Kraepelin  has  grouped  them  or  at  least 
that  a  simpler  classification  may  be  offered  as  a  working  basis 
to  understand  the  reactions  of  these  individuals.     He  says : — 

"I  propose  to  classify  the  individuals  who  present  mental 
or  social  difficulties  in  three  groups.  These  groups  are  under- 
stood to  be  meant  as  symbols  for  unknown  quantities  rather 
than  as  explanation  or  precise  definitions.  The  three  groups 
are,  in  the  first  place,  the  group  in  which  the  intelligence  is 
found  to  be  below  the  lowest  normal  level.  This  is  called  the 
group  of  defectives  or  the  inadequate.  Into  this  group  fall  the 
feeble-minded,  the  'Oligophrenias'  of  Kraepelin,  the  end  states 
of  dementia  praecox,  and  of  other  deteriorating  psychoses,  of 
presenile,  organic  dementia,  and  so  forth. 

"The  next  group,  emotionally  unstable,  includes  individuals 
who  have  average  intelligence  or  better,  but  who  show  in  their 

^  Adler,  Herman  M.,  M.D.  In  Journal  of  the  American  Institute  of  Criminal  Law 
and  Criminology,  Vol.  8,  No.   1,  May,  1917,  pp.  45-68. 


488  THE    KINGDOM    OF    EVILS 

conduct  and  in  their  careers  the  predominating  influence  of  the 
emotions.  They  are  moody,  changeable,  impulsive,  and  in  gen- 
eral it  may  be  said  that  their  conduct  itself  does  not  correspond 
to  their  beliefs,  or  intentions. 

"The  third  group,  the  paranoid,  includes  individuals  of  aver- 
age intelligence  or  better  in  whose  careers  the  emotional  in- 
fluences are  of  secondary  importance,  but  whose  main  difficul- 
ties are  a  result  of  mistakes  in  logical  thought  processes.  The 
well-known  characteristics  which  are  exhibited  in  extreme  form 
by  the  paranoid  psychoses,  these  individuals  show  often  to  a 
degree  which  falls  just  short  of  a  delusional  state,  egocentric 
ideas,  and  prejudices.  Everything  that  occurs  about  them  is 
referred  to  themselves.  Their  first  reaction  is  to  determine 
what  effect  any  extraneous  circumstance  may  have  upon  them- 
selves. They  are  selfish,  vain,  arrogant.  If  they  feel  in 
optimistic  mood,  they  are  contemptuous  of  others.  If  de- 
pressed, they  are  resentful.  Though  this  is  a  trait  of  their 
intellect,  it  does  not  necessarily  interfere  with  their  intellectual 
abilities,  and  these  people  are  often  very  efficient. 

"These  three  groups  can  be  separated  only  theoretically. 
There  are  many  cases  that  are  composite,  so  that  their  charac- 
teristics fall  into  two  or  into  all  of  these  groups.  Thus,  few 
paranoid  individuals  go  through  life  without  strong  emotional 
reactions  which  often  lead  to  social  difficulties.  Similarly,  the 
emotionally  unstable  will,  especially  during  paroxysms  of  rage 
or  depression,  often  exhiliit  paranoid  symptoms.  The  defective 
group  may  show  paranoid  tendencies  and  emotional  instability. 

"The  distinction  lies  rather  in  the  behaviour  of  the  individual 
as  observed  in  the  course  of  years  than  in  a  definite  quantitative 
difference  to  be  observed  at  a  single  examination.  The  intro- 
spective psychologist  will  attempt  to  determine  in  each  indi- 
vidual by  psychoanalysis  or  other  means  what  the  mechanism 
of  the  disturbance  is.  He  may  succeed  in  doing  this,  and  still 
be  unable  to  predict  the  future  course  of  the  individual. 

"The  behaviourist  psychologist  will  not  lay  too  much  weight 
on  the  results  of  a  single  examination  by  whatever  method,  but 
will  lay  more  emphasis  upon  the  history  of  the  case,  and  the 
previous  experiences  of  the  individual  and.  above  all.  upon  the 
reaction  of  the  individual  to  certain  test  situations  during  a  pe- 
riod of  observation.  This  behaviourist  method  offers  the  hope 
of  a  short  cut  in  dealing  with  these  individuals." 

Dr.  Adler  then  gives  some  considerations  of  a  practical 
nature  upon  which  to  base  the  care  and  treatment  of  such 
people.     We  quote : — 


THE    KINGDOM    OF    EVILS  489 

"In  every  given  case  of  delinquency  or  social  difficulty  it 
should  be  determined  whether  the  difficulty  is  chiefly  due  to  in- 
adequate intelligence,  to  emotional  instability  or  to  paranoid  dis- 
position. Nothing  can  be  gained  by  endeavoring  to  increase  the 
intelligence  of  a  mental  defective.  Nothing  can  be  expected 
from  an  attempt  to  change  the  personality  of  the  paranoid  in- 
dividual. A  great  deal  can  be  accomplished,  however,  in  con- 
trolling the  emotional  instability  of  those  whose  chief  difficulty 
is  the  result  of  such  instability  as  well  as  the  emotional  diffi- 
culties of  the  paranoid  and  defective  group. 

"Classification  such  as  the  one  suggested  in  this  communica- 
tion is,  of  course,  entirely  too  simple  to  completely  satisfy  all 
the  demands  in  the  individual  cases,  and  it  is  to  be  hoped  that 
this  classification  may  be  altered  and  amplified,  or  perhaps  com- 
pletely reconstructed  till  finally  a  working  method  may  result, 
but  even  now,  without  general  information  of  the  subject,  such  a 
simple  scheme  as  this  one  proposed  has  served  not  only  to  keep 
the  ideas  of  the  examiner  grouped  in  orderly  fashion,  and  this 
to  prevent  disorderly  and  unclear  thinking  on  his  part,  but  it  has 
actually  appeared  to  be  of  benefit  when  it  was  applied  as  a  basis 
of  therapy  in  these  cases." 

A  variety  of  character  defects  was  shown  by  the  twenty- 
eight-year-old  Harriet  Farmer  (case  94)  who,  after  a  history 
of  unreliability,  a  long  period  of  fabrication,  alcoholism,  and 
inability  to  make  her  own  way,  came  to  the  attention  of  the 
Psychopathic  Hospital  as  the  result  of  a  suicidal  attempt.  She 
clearly  fitted  into  the  group  of  psychopathic  personalities.  The 
outcome  of  the  case  showed  how  much  improvement  a  char- 
acter of  this  type  is  capable  of  making  when  handled  by  social 
workers  guided  by  psychiatric  knowledge. 

That  the  type  of  hypoboulic  (weak-willed)  individuals  who 
despite  a  sufficient  modicum  of  intelligence  are  fated  to  be 
failures  because  of  their  defect  is  illustrated  by  Louis  Sand 
(case  95).  A  Belgian  of  considerable  education,  with  the 
best  intentions  in  the  world,  with  ambition  but  without  power 
of  concentrated  effort,  he  had  wandered  from  place  to  place. 
Such  might  be  considered  the  classical  type  of  constitutional 
inferior. 

The  case  of  Theresa  Beauvais  (case  96)  should  be  a  liberal 
lesson  to  the  moralist  and  social  worker.  Sexual  immorality 
in  this  girl  is  explained  on  the  basis  of  a  hypersexuality  which 
might  be  characterized  as  falling  into  the  group  of  psycho- 


490  THE    KINGDOM    OF   EVILS 

pathia  sexualis  or  into  the  larger  group  of  constitutional 
psychopathic  inferiority.  Her  promiscuity  is  to  be  considered 
rather  as  a  symptom  of  a  disease  than  as  a  pure  moral  deflec- 
tion. With  a  background  of  exceedingly  poor  heredity  ( father 
a  professional  thief,  mother  a  prostitute)  and  as  vicious  an 
early  environment  as  could  be  conceived,  one  is  justified  in  ex- 
pecting a  rather  poor  social  result.  Theresa  certainly  showed 
enough  evidence  of  instability,  will  defect,  and  emotional  out- 
'-breaks  to  justify  a  diagnosis  of  psychopathic  inferiority  or 
ipsychopathic  personality.  Appearances  might  have  led  to  the 
conclusion  that  this  girl  was  a  moron,  but  psychological  tests 
showed  her  of  sufficient  intellectual  ability.  It  was  rather  in 
the  sphere  of  affectivity  and  will  that  the  disorder  lay.  It  is 
quite  important  to  keep  this  idea  in  mind ;  namely,  that  the 
affective  life  and  the  will  are  often  more  important  in  deter- 
mining the  social  reactions  of  an  individual  than  the  intellect 
alone.  One  cannot  avoid  the  assumption  that  it  would  take 
more  than  the  ordinary  amount  of  will-power  to  overcome  the 
sexual  desires  of  such  a  hypersexual  individual,  and  one  would 
be  expecting  too  much  if  one  hoped  for  a  great  deal  of  steady- 
ing of  such  a  person  after  adult  life  had  been  reached  and 
many  pernicious  habits  had  been  formed  in  youth,  but  one 
should  have  sympathy  for  this  girl  as  a  victim  of  disease  rather 
than  as  merely  vicious.  One  arrives  at  this  conclusion  from 
a  psychiatric  study  of  the  whole  life  of  the  patient. 

The  value  of  the  psychiatric  attack  on  a  patient  not  neces- 
sarily markedly  psychopathic  is  discussed  in  the  case  of  Leon 
Blumer  (case  97).  Pseudologia  fantastica,  or  pathological 
lying,  falls  under  the  general  heading  of  the  psychopathic  per- 
sonality or  constitutional  psychopathic  inferiority.  It  is 
usually  associated  with  other  evidence  of  character  defect  or 
psychopathia.  A  person  afflicted  with  this  type  of  abnormality 
is  certain  to  be  considered  a  "difficult  case"  and  pretty  thor- 
oughly disliked  by  those  with  whom  he  comes  into  association. 
This  was  indeed  the  fact  with  Francis  Corcoran  (case  98). 

The  results  of  a  constitutional  inferiority  may  only  be 
brought  about  under  the  stress  of  circumstances.  Manuel 
Giordani  (case  99),  a  flute-player,  got  along  well  enough  in 
civilian  life,  but  under  the  stress  of  military  training  he  had 
a  psychopathic  upset  which  resulted  in  his  discharge  from  the 
army.     Back  in  civilian  life,  he  again  succeeded. 


THE    KINGDOM    OF    EVILS  49I 

Until  his  fiftieth  year  Henry  Allen  (case  lOo)  had  been 
considered  from  the  results  of  his  work,  merely  as  a  not  very 
efficient  constructional  designer.  A  personality  study  at  the 
age  of  fifty  by  a  psychiatrist  brought  out  the  fact  that  he  was 
of  a  melancholy  disposition,  unhappy  in  his  work  because  he 
believed  he  was  being  made  fun  of  by  his  fellow  employees. 
He  disliked  the  type  of  work  he  was  doing  and  considered  him- 
self only  twenty-five  per  cent  efficient,  and  felt  that  he  was 
physically  ill.  Considering  Allen  from  this  point  of  view,  it 
was  possible  to  change  his  working  conditions,  encourage  him 
and  give  him  a  type  of  work  that  was  more  to  his  taste.  Where- 
upon he  developed  greater  efficiency  and  was  able  to  earn  twice 
as  much  as  previously.  This  type  of  analysis  has  great  pros- 
pects from  the  vocational-guidance  standpoint,  and  can  add  to 
the  efficiency  of  the  individual  both  to  the  benefit  of  himself 
and  of  the  firms  employing  him. 


RECENT  APPLICATIONS  OF  MENTAL 
HYGIENE 

MENTAL   DISEASE    IN    THE   GREAT    WAR 

Military  experience  in  the  Great  War  brought  out  many 
cases  of  mental  disorder,  and  showed  the  large  part  that  the 
psychology  of  individuals  played  in  their  adjustment  to  mili- 
tary conditions.  Twenty-five  cases  are  submitted  in  this  work 
to  illustrate,  in  part,  some  of  the  problems  with  which  the 
military  service,  the  public  health  service,  and  the  Red  Cross 
have  had  to  deal. 

In  any  large  group  of  men,  it  is  of  course  evident  that  all 
varieties  of  mental  disease  will  be  found  to  occur,  and  among 
the  four  million  men  in  the  American  military  service,  there 
were  of  course  all  varieties  of  mental  disorder  and  difficulty. 
The  term  "shell-shock"  which  grew  up  at  the  beginning  of  the 
war  from  the  experience  of  the  English  has  led  to  great  con- 
fusion in  terminolog}'.  Originally  applied  by  the  British  to 
cases  of  mental  disorder,  mostly  of  the  type  of  psychoneuroses, 
under  the  misapprehension  that  these  conditions  were  the  effect 
of  high  explosives,  it  has  been  used  variously  to  include,  on 
the  one  hand,  only  the  pure  psychoneurotic  manifestations, 
and,  on  the  other  hand,  to  include  all  types  of  mental  disorder. 
This  matter  has  been  treated  in  full  detail  in  a  book  recently 
published  by  the  senior  author  under  the  title,  Shell-Shock. 

The  Great  War  brouglit  out  a  large  number  of  cases  of 
psychoneurotic  disorder,  to  which  a  great  deal  of  attention  has 
been  paid.  The  American  Army  treated  these  cases  abroad,  in 
large  measure,  at  base  hospital  number  117,  known  colloqui- 
ally as  the  "Shell-Shock  Hospital."  A  description  of  these 
cases  is  very  adequately  presented  in  a  book  by  Schwab  and 
Fenton,  entitled,  The  Psychology  of  Conflict.  On  the  whole 
it  may  be  said  that  there  are  no  new  problems  rising  out  of 
the  psychiatric  cases  occurring  in  the  military  service.  Many 
of  the  mental  difficulties  would  have  occurred  to  the  same 
patients  in  civilian  life.  However,  the  fact  that  they  did  occur 
in  military  service  has  added  a  very  natural  sentimental  inter- 

492 


THE    KINGDOM    OF    EVILS  493 

est,  which  would  probably  not  have  been  accorded  these  same 
patients  had  their  difficulty  occurred  during  ordinary  peace 
times. 

A  new  interest  in  mental  disease  has  been  awakened  and 
this  is  particularly  true  in  Great  Britain,  where  a  veritable 
renaissance  has  occurred.  This  has  been  one  of  the  subsidiary 
benefits  of  the  war.  The  American  Red  Cross  has  established 
psychiatric  social  units  throughout  the  country,  and  the  prob- 
lems that  confront  these  psychiatric  social  units,  as  will  be  seen 
by  a  perusal  of  the  war  cases  herein  described,  are  in  no  par- 
ticular way  different  from  psychiatric  social  problems  of  our 
civilian  population.  It  is,  therefore,  proper  to  employ  the  same 
technique,  medical  and  social,  in  the  handling  of  the  war  neu- 
roses and  psychoses  that  is  applied  to  the  civil  cases.  As  will 
be  seen,  many  of  the  military  cases  have  been  turned  over  to 
civilian  hospitals. 

One  feature  that  is  present  in  the  military  cases,  which  is 
not  often  found  in  the  civilian  ones,  is  that  of  pecuniary  com- 
pensation. When  the  mental  disorder  "did  not  exist  prior  to 
enlistment"  and  occurred  "in  line  of  duty"  it  has  been  generally 
held  that  the  patient  is  entitled  to  compensation  for  disability. 
The  situation  in  this  regard  is  similar  to  that  which  would 
hold  for  tuberculosis  or  any  other  chronic  disease. 

Seven  of  the  eleven  psychotic  groups  that  have  been  de- 
scribed are  exemplified  by  the  twenty-five  patients  having  rela- 
tions with  the  military  service. 

Carl  Spindler  (case  43)  and  Thomas  Scannell  (case  44) 
were  patients  suffering  with  syphilopsychosis.  Carl  Spindler 
was  transferred  to  a  civilian  hospital  with  a  diagnosis  of  gen- 
eral paresis.  Symptoms  of  this  disease  had  developed  while 
he  was  in  the  service,  but  the  syphilitic  infection  which  led  to 
the  development  of  paresis  was  acquired  long  before  entering 
the  service.  Nevertheless,  it  is  often  assumed  in  these  cases, 
that  the  government  is  somewhat  liable  in  the  way  of  com- 
pensation, the  argument  being  that  the  mental  symptoms  de- 
veloped during  service,  they  were  not  present  prior  to  enlist- 
ment, and  that  possibly  these  symptoms  would  not  have  arisen 
had  the  patient  not  undergone  the  hardships  of  military  life. 

Thomas  Scannell  was  probably  a  case  of  juvenile  paresis, 
that  is,  he  had  the  symptoms  of  general  paresis  which  had 
developed  from  congenital  syphilis.     He  was  being  cared  for 


494  THE    KINGDOM    OF    EVILS 

by  the  Red  Cross.  Here,  again,  the  same  question  would  arise 
as  to  whether  or  not  the  government  was  responsible  for  his 
care  on  the  grounds  that  his  mental  enfeeblement  had  occurred 
while  he  was  in  the  military  service. 

The  problem  of  feeble-mindedness  was  much  diminished  in 
the  army  by  the  psychological  testing  and  the  rejection  of 
feeble-minded  individuals  by  the  neuropsychiatric  division. 
Despite  this,  many  feeble-minded  were  in  the  army,  and  it 
was  held  by  many  that  for  certain  work  behind  the  lines  the 
feeble-minded  had  a  very  definite  place.  However  this  may 
be,  there  were  numerous  examples  of  the  feeble-minded  in  the 
army.  The  navy  and  the  marine  corps  were  not  so  careful 
to  eliminate  individuals  of  low  mental  status. 

Thomas  Fuller  (case  9)  had  had  a  bad  record  in  civilian 
life.  It  was  felt  that  this  was  largely  the  result  of  his  mental 
retardation,  his  mental  age  being  only  9.2  years.  Despite  this 
fact,  he  made  good  in  the  marines,  and  even  rose  to  the  rank 
of  corporal.  The  obvious  reason  is  that  under  proper  super- 
vision a  person  of  inferior  mentality  may  be  a  very  valuable 
worker. 

It  does  not  follow,  however,  that  all  feeble-minded  indi- 
viduals make  good  under  the  type  of  supervision  given  in  the 
army  or  navy.  Bernard  Bornstein  (case  50)  did  fairly  well 
in  civilian  life,  earning  between  fifteen  and  twenty  dollars  a 
week,  but  was  quite  unable  to  succeed  when  he  joinetl  the  navy. 
His  mates  plagued  him  and  he  was  such  a  misfit  that  it  was 
necessary  to  discharge  him.  The  feeble-minded  individual  is 
likely  to  be  unreliable,  and  when  this  is  markedly  the  case,  he 
cannot  be  of  course  fitted  into  the  discipline  of  military  service. 

The  sort  of  difficulty  that  a  feeble-minded  individual  may 
get  into  in  the  army  is  well  illustrated  by  the  case  of  Howard 
Driscoll  (case  51).  His  army  record  was  sprinkled  with 
A.W.O.L.'s  and  after  his  discharge  from  the  army  he  was  sen- 
tenced to  a  reformatory.  He  returned  to  the  army  during  the 
war,  where  he  got  into  difficulty  by  leaving  his  post  for  four 
days  because  he  got  angry.  He  did  not  receive  the  treatment 
that  would  ordinarily  be  accorded  to  a  normal  individual,  but 
was  given  his  discharge  as  a  feeble-minded  person.  Super- 
vision will  be  necessary  for  this  man  throughout  life  and  he 
would  probably  be  best  served  if  he  could  be  put  under  the 
paternal  care  of  an  institution. 


THE    KINGDOM    OF    EVILS  495 

One  of  the  important  pieces  of  neuropsychiatric  informa- 
tion that  came  out  of  the  army  experience  was  the  frequency 
of  epilepsy  in  the  community  at  large.  In  our  series  four  cases 
of  epileptic  psychosis  are  presented  in  patients  who  came  within 
the  purview  of  the  military  service.  John  Manaos  (case  29) 
was  arrested  for  not  properly  filling  out  his  draft  papers.  In 
prison  he  developed  a  clouded  mental  state,  and  at  the  hospital 
the  diagnosis  of  epilepsy  was  made.  Upon  this  finding,  of 
course,  the  charges  against  him  were  dropped,  as  it  was  felt 
that  he  was  not  a  responsible  individual. 

Charles  Lovell  (case  55)  was  given  his  discharge  from  the 
army  because  of  epileptic  attacks.  The  epileptic  phenomena 
occurred  for  the  first  time  while  in  the  army  service  in  the 
cases  of  Frank  Wayne  (case  56)  and  John  Bristol  (case  57). 
Wayne  had  been  a  weakling  throughout  his  life,  was  recog- 
nized as  somewhat  simple-minded,  and  incapable  of  hard  work. 
Under  the  stress  of  the  army,  the  seizures  of  epilepsy  made 
their  appearance,  and  after  discharge  he  was,  of  course,  a  sub- 
ject for  compensation.  John  Bristol,  on  the  other  hand,  had 
been  a  very  healthy  and  stalwart  individual,  serving  on  the 
police  force  before  his  enlistment,  and  being  athletic  instructor 
at  camp.  For  some  reason,  seizures  began  after  typhoid  inocu- 
lation, and  have  continued  with  great  frequency  to  the  present 
time.  He  is,  therefore,  another  subject  for  compensation,  and 
has  been  obtaining  assistance  from  the  Red  Cross  in  securing 
work  that  he  is  capable  of  performing. 

The  types  of  manic-depressive  psychosis  will  have  to  be 
considered.  In  a  general  way,  it  was  considered  before  the 
war  experience  was  at  hand  that  the  conditions  of  the  military 
service  would  produce  a  great  many  cases  of  manic-depressive 
psychosis,  and  that  the  individual  who  had  had  a  psychosis 
would  be  very  likely,  indeed,  to  break  down. 

Robert  MacPherson  (case  85)  developed  a  hypomanic  con- 
dition which  was  probably  the  cause  of  his  discharge  from 
military  service. 

On  the  other  hand,  Clarence  Adams  (case  86)  had  had 
psychotic  symptoms  from  which  he  recovered  before  entering 
the  service.  He  did  very  well,  being  at  the  front  and  being 
gassed  without  having  any  return  of  his  symptoms.  After  his 
discharge,  while  in  civilian  life,  he  again  developed  psychotic 
symptoms  which  led  him  to  the  hospital.     It  is  indeed  to  be 


496  THE    KINGDOM    OF   EVILS 

borne  in  mind  that  the  change  from  the  military  back  to 
civihan  Hfe  is  quite  a  severe  shock  at  times,  and  it  takes  a 
considerable  amount  of  ability  to  make  a  successful  and  easy 
change. 

Dementia  praecox  cases  were  frequent  enough  during  the 
war,  and  are  still  occurring  as  a  problem  in  men  who  have 
been  in  the  service.  If  there  is  one  feature  that  might  be  con- 
sidered as  somewhat  different  in  the  military  cases  from  those 
in  civil  life,  it  is  that  the  prognosis  of  soldiers  who  were  ap- 
parently schizophrenic  was  much  better  during  the  war  period 
than  in  the  usual  prognosis  of  this  type  of  case  as  seen  in  civil 
life. 

Of  the  war  cases  described  in  this  book,  five  had  the  diag- 
nosis of  dementia  praecox.  Kevork  Ardinian  (case  26)  was 
never  actually  in  the  army,  but  was  picked  up  under  the  "Work 
or  Fight"  law  after  which  it  was  discovered  that  he  was  really 
a  victim  of  dementia  praecox. 

George  Stone  (case  76)  had  done  well  in  the  army,  where 
he  had  won  the  croix  de  guerre.  After  his  discharge  he  de- 
veloped a  psychosis  which  was  diagnosed  as  dementia  praecox, 
and  while  outside  of  an  institution  he  gave  a  good  deal  of 
concern  to  the  Red  Cross. 

Howard  Lancaster  (case  79),  on  the  contrary,  developed 
his  mental  symptoms  while  in  the  army  and  did  well  when  he 
returned  to  civilian  life.  Whereas  George  Mullen  (case  yy) 
was  much  like  Clarence  Adams  (case  86).  Mullen  was  com- 
mitted as  a  case  of  dementia  praecox  in  191 5,  but  was  dis- 
charged. He  joined  the  English  Army,  where  he  did  well,  and 
was  given  an  honorable  discharge  after  being  wounded.  On 
his  return  to  civilian  life,  he  developed  a  psychosis  which 
brought  him  into  an  institution  with  the  diagnosis  of  dementia 
praecox. 

Major  Mark  Dobson  (case  80)  would  have  been  in  very 
serious  difficulty  for  forgery  had  his  condition  not  been  recog- 
nized as  dementia  praecox. 

The  cases  in  the  psychoneurotic  group  were  very  frequent 
throughout  the  war.  Abroad  they  came  chiefly  under  the  acute 
manifestations  of  shell-shock.  The  cases  as  seen  in  America, 
following  the  war,  or  during  the  war  among  those  patients 
who  had  not  been  abroad,  were  very  much  less  dramatic. 

James   Bailey    (case   7)    developed  neurasthenic   symptoms 


THE    KINGDOM    OF    EVILS  497 

following  a  street-car  accident.  These  symptoms  did  not  give 
him  very  much  difficulty,  however,  until  he  was  at  camp,  when 
they  became  quite  manifest,  and  led  to  his  discharge. 

A  good  example  of  traumatic  hysteria  is  presented  by 
Walter  Nelson  (case  91)  who  developed  his  symptoms  fol- 
lowing a  blow  on  the  head  by  a  tent-pole  which  blew  over  in 
the  wind.  His  symptoms  were  those  that  one  ordinarily  sees 
from  the  same  type  of  injury  in  civilians,  but,  occurring  while 
he  was  in  the  aviation  service,  it  was  distinctly  a  psychoneu- 
rosis  occurring  in  the  military  service. 

Martin  O'Hara  (case  92)  had  had  evidences  of  hysteria 
before  his  army  experiences.  He  was  discharged  from  the 
army  for  physical  disability,  and  after  getting  into  an  un- 
pleasant marital  arrangement,  developed  his  hysterical  symp- 
toms again. 

The  picture  of  neurasthenia  was  not  an  infrequent  one  in 
the  military  service.  An  example  is  given  in  the  case  of  Joseph 
Levenson    (case  93). 

The  constitutional  psychopathic  inferiors  presented  them- 
selves to  the  military  surgeons  in  considerable  numbers,  and 
their  vagaries  will  be  before  the  people  who  deal  with  returned 
soldiers  for  many  years  to  come.  Francis  Corcoran  (case  98) 
had  been  a  ne'er-do-well  all  his  life.  After  his  military  expe- 
rience, he  became  a  burden  to  the  public  health  service,  and 
will  probably  remain  a  "case"  for  many  years.  Paul  Daw- 
son (case  78)  had  been  discharged  from  the  army  for  mental 
disease,  both  at  the  time  of  the  Mexican  border  affair,  and 
during  the  Great  War.  He  claims  that  in  both  these  instances 
he  malingered.  As  a  rule  it  is  true  that  individuals  malingering 
mental  disease  are  really  the  victims  of  some  form  of  mental 
disease.  Whether  or  not  Paul  Dawson  was  a  case  of  dementia 
praecox,  as  some  considered,  or  of  psychopathic  personality, 
it  is  hard  to  state.  At  any  rate,  he  did  not  fit  into  the  condi- 
tions of  military  life. 

From  the  standpoint  of  the  psychiatric  social  worker,  the 
military  man  may  be  of  interest  not  as  the  main  actor  in  the 
drama,  but  as  a  subsidiary.  Thus,  Elliot  Calderwood  (case 
22)  who  was  thought  to  be  more  sinned  against  than  sinning, 
as  he  had  been  deserted  by  his  father,  a  soldier  in  the  Cana- 
dian Army.  Nora  McCarthy  (case  74)  was  the  fiancee  of  a 
soldier  and  was  pregnant.     Her  mental  difficulties  arose  aftey 


498  THE    KINGDOM    OF    EVILS 

his  departure  for  France,  and  were  to  a  large  degree  patched 
up  by  marriage  after  his  return  from  overseas. 


MENTAL    HYGIENE    OF    INDUSTRY 

There  are  at  least  forty-two  cases  in  this  volume  that  have 
interest  from  the  standpoint  of  the  new  mental  hygiene  of 
industry,  a  movement  which  we  conceive  may  prove  of  pri- 
mary value  in  the  general  social  situation  of  the  world.  But 
we  also  know  that  it  will  be  difficult  to  persuade  either  the 
theoretical  psychiatrist  or  the  practical  industrialist  that  he 
must  build  his  sociology  or  his  practical  plan  of  meeting 
the  economic  unrest,  from  the  very  bottom,  namely  from 
the  individual.  The  standpoint  of  theoretical  sociology  and 
likewise  the  standpoint  of  practical  industrialism  has  interested 
itself  in  man's  movements  rather  than  in  the  individual.  Mod- 
ern sociology  feels  Herbert  Spencer  too  much  of  an  indi- 
vidualist, yet  some  sociologists  note  with  alarm  the  generality 
of  sociologists.  Ross  says :  "How  futile  is  the  endeavor  to 
establish  laws  of  succession  based  on  the  parallelism  in  all 
societies  of  any  special  development  (e.g.,  domestic  or  politi- 
cal) taken  in  its  entirety.  The  error  here  lies  in  taking  too 
large  a  unit  of  social  life."  Tarde  also  is  right  in  saying, 
"This  attempt  to  confine  social  facts  within  lines  of  develop- 
ment, which  would  compel  them  to  repeat  themselves  en  masse 
with  merely  insignificant  variations,  has  hitherto  been  the  chief 
pitfall  of  sociology."  "Even  the  keen-eyed  Marx,"  says  Ross, 
"opposes  to  a  social  Past  dominated  by  class  struggle  a  class- 
less, strifeless  Future  under  the  collectivist  regime."  But  he 
does  not  come  down  upon  the  individual  as  the  true  bottom 
factor.  "The  individual,"  says  he,  "is  a  true  factor,"  but  he 
goes  on  to  identify  individualism  with  the  "Great-Man"  theory 
and  says,  "There  is  little  of  value  in  the  Great-Man  theory, 
which  sets  up  a  Hero  for  each  epoch  or  movement  and  subjects 
multitudes  of  men  through  centuries  to  the  spell  of  his  purpose 
or  ideal."  He  continues,  "We  cannot  take  the  individual  as  our 
unit."  Groups,  relations,  institutions,  imperatives,  uniformi- 
ties are  five  units  favorably  considered  by  Ross  who  says 
"They  precede  the  individual  and  they  survive  him ;  neverthe- 
less they  have  all  risen  at  some  time  out  of  the  actions  and  in- 
teractions  of   men.      To   understand    their   jrenesis   we   must 


THE    KINGDOM    OF    EVILS 


499 


ascend  to  that  primordial  fact  known  as  the  social  process/' 
From  our  point  of  view  we  rather  hold  that  these  social  prod- 
ucts can  best  be  studied  by  analyses  of  interactions  of  men 
starting  even  in  the  simplest  groups.  This  point  of  view  is  as 
true  in  industrial  psychiatry  as  in  other  situations. 

We  found  that  many  of  our  patients  who  were  started  on 
an  industrial  decline  were  competent  and  even  excellent  work- 
men, and  that  with  a  little  assistance  in  adapting  themselves 
to  their  employment  and  an  explanation  of  their  condition  to 
their  employers,  they  could  be  refitted  into  industry.  This 
led  at  once  to  the  idea  that  similar  methods  of  understanding 
and  assistance  might  keep  other  employees  from  falling  into 
the  condition  of  hospital  patients,  and  further  to  the  thought 
that  mental  hygiene,  necessary  for  the  psychopathic  employee, 
would  be  beneficial  to  all  persons  in  employment  to  the  end  of 
promoting  their  efiiciency  and  personal  satisfaction.  A  com- 
mittee was  formed  in  1914  to  carry  on  a  special  investiga- 
tion of  the  subject,  on  which  psychiatry  was  represented  by 
Dr.  Herman  Adler  and  industry  by  Robert  Valentine.  A  spe- 
cial social  worker  for  psychopathic  employees  was  engaged, 
and  men  patients  between  the  ages  of  twenty-five  and  fifty-five 
were  selected  for  the  study.  In  addition  to  the  cases  assisted, 
industrial  histories  over  a  period  of  five  years  have  been  se- 
cured for  two  hundred  and  fifty  cases.  The  continuation  of 
this  study  until  1920  was  made  possible  by  contributions  from 
the  Committee  of  the  Permanent  Charity  Fund,  Incorporated, 
Boston  Safe  Deposit  and  Trust  Company,  Trustee. 

As  an  outgrowth  of  this  work,  the  Engineering  Foundation 
of  New  York,  in  191 9,  undertook  an  investigation  of  the  pos- 
sible applications  of  psychiatry  in  industry.  The  term  "mental 
hygiene  of  industry"  was  devised  by  the  senior  author  to  in- 
clude the  contributions  of  three  fields — psychiatry,  psychology, 
and  psychiatric  social  work.  Four  papers  were  written  as  a 
result  of  this  inquiry.^ 

One  of  our  anchor  cases,  Henry  Loyal,  steamfitter  (case  4), 

»  Southard,    E.    E.,    M.D.:       "The    Movement    for    a    Mental    Hygiene    of    Industry," 
Mental  Hygiene,  January,   1920.     Also  Industrial  Management,^  February,    1920. 

"The   Modern   Specialist  in  Unrest:   A  Place   for  the   Psychiatrist  in  Industry," 

The  Journal  of  Industrial  Hygiene,  May,   igzo.     Also  Mental  Hygiene,  July,   1920. 
Trade    Unionism    and    Temperament:    Notes    Upon    the    Psychiatric    Point    of 


View  in  Industry."  Mental  Hygiene,  April,   1920. 

Jarrett,   Mary   C:      "The   Mental  Hygiene   of   Industry:    Report   of   Progress  on    Work 

Undertaken   under  the    Engineering  Foundation   of   New   York,"   Mental   Hygiene, 

October,  1920.     Also  Proceedings  of  the  National  Conference  of  Social  Work,  1920. 


500  THE    KINGDOM    OF    EVILS 

was  a  productive,  competent,  skilled  worker  and  for  the  most 
part  fairly  steady  in  employment.  The  irregularity  in  his 
employment  was  due  to  his  mental  disease,  his  psychopathic 
personality  with  its  periodical  waves.  He  should  not  figure  in 
the  turnover  analyses. 

The  Portuguese  laborer,  John  Manaos  (case  29),  epileptic, 
was  an  irregular  worker  and  brings  up  certain  problems  of 
epilepsy  which  every  employer  of  labor  should  bear  in  mind. 
On  the  one  hand  epileptics  are  prone  to  exhibitions  of  extreme 
irascibility  and  bad  humor  from  time  to  time.  On  the  other 
hand  they  are  often  of  a  strongly  religious  cast  exceedingly 
faithful  in  work,  as  shown  to  the  most  casual  visitor  at  insti- 
tutions for  epileptics  where  even  the  so-called  insane  are  under 
proper  conditions  made  to  work  ably  and  willingly. 

The  nickel-polisher,  Luigi  Silva  (case  53)  is  another  epilep- 
tic unable  to  work  in  a  community  but  finally  successfully  put 
to  work  on  a  farm. 

The  chemist  John  Logan  (case  58)  was  a  most  steady  em- 
ployee and  most  valuable  to  his  firm.  In  fact  his  firm  was 
willing  to  allow  occasional  absences  due  to  his  alcoholic  at- 
tacks. There  can  be  no  doubt  that  these  occasional  alcoholics 
would  be  greatly  benefited  if  the  plants  employing  them  Avould 
call  upon  consultant  psychiatrists  for  analyses  of  these  often 
very  valuable  men.  In  fact  such  alcoholics  might  be  saved 
almost  completely  for  the  community. 

The  salesman  Paul  Ernst  (case  y2>)  ^^as  a  victim  of  periodic 
disease,  manic-depressive  psychosis  (at  first  thought  to  be  a 
case  of  dementia  praecox). 

The  waiter  William  Donahue  (case  82)  had  always  been 
irregular  in  employment.  His  irregularity  was  no  doubt  due 
to  the  same  cause  as  that  operating  in  Paul  Ernst.  Another 
type  of  irregular  worker  is  found  in  Louis  Sand  (case  95) 
who  was  a  rover  and  had  worked  during  five  years  in  as  many 
as  twelve  states,  having  originally  wandered  from  Belgium 
where  he  had  been  well  educated  and  came  from  a  good  family. 
We,  however,  likewise  were  unsuccessful  in  keeping  him  at  a 
job  for  more  than  a  few  months. 

There  may  be  more  types  of  irregular  employment  than  here 
illustrated.  We  have  seen  instances  of  the  periodic  disease, 
manic-depressive  psychosis,  and  of  the  permanent  disease 
epilepsy,  both  of  which  may  lead  to  irregularity  of  employ- 


THE    KINGDOM    OF    EVILS  5OI 

ment  due  to  the  mental  disorder.  Especially  in  the  case  of 
manic-depressive  psychosis  will  it  be  true  that  mild  attacks  of 
depression  hardly  visible  to  the  lay  observer  may  lead  to  the 
throwing  up  of  a  job  and  to  premature  discharge.  Some  of 
these  are  amongst  the  cleverest  workmen  and  the  fact  that 
they  figure  at  all  in  the  turnover  is  probably  on  the  whole  a 
great  loss  to  industry.  We  have  seen  instances  of  periodic 
alcoholism  (the  laity  is  familiar  with  these  cases  under  the 
name  of  dipsomania)  and  have  called  attention  to  the  sales 
values  to  industry  of  some  of  these  men.  Indeed  employers 
are  fairly  familiar  with  the  necessity  of  letting  these  men 
have  their  sprees.  We  have  become  familiar  with  the  rover  or 
victim  of  wanderlust,  a  tendency  perhaps  allied  to  that  shown 
in  the  psychopath  Henry  Loyal  (case  4). 

Alfred  Mack,  the  packer  (case  6),  was  one  of  our  industrial 
successes.  A  man,  it  will  be  remembered,  made  better  than 
he  was  to  start  with.  His  physical  disability  was  removed  and 
his  alcoholism  stopped.  He  has  since  remained  a  steady 
worker  and  one  of  the  best  employees  in  his  plant.  We  might 
count  the  case  of  the  woman  who  lived  as  a  man,  the  factory 
worker  Julia  Brown  (case  23),  as  another  instance  of  alco- 
holism with  certain  complications  of  character,  who  after  social 
treatment  became  a  competent  and  trusted  worker  in  her  plant. 

The  real  estate  sales  agent,  John  Sullivan  (case  60),  had 
a  bad  attack  of  alcoholic  hallucinosis  but  was  encouraged  to 
discontinue  alcohol  and  did  so.  He  was  advised  to  return  to 
gardening  and  did  well  at  it.  Another  alcoholic,  Patrick 
Nolan  (case  59),  returned  to  work  after  D.  T.'s  that  lasted 
ten  days.  He  has  since  discontinued  alcohol.  National  pro- 
hibition will  tend  to  solve  many  of  these  problems  but  we 
must  not  be  too  optimistic  concerning  the  relief  of  all  prob- 
lems of  alcoholism  by  prohibition.  We  do  not  here  refer  to 
the  possibility  of  getting  alcohol  illegally.  We  refer  rather 
to  the  fact  that  alcoholism  when  it  reaches  the  psychopathic 
degree  or  comes  out  in  a  psychopathic  way  is  perhaps  per- 
mitted to  do  so  by  some  hereditary  taint  or  acquired  soil  in 
the  nervous  system.  We  may  look  now  for  the  pure  illustra- 
tion of  such  hereditary  taint  or  acquired  soil  in  persons  who 
can  punctuate  such  taint  or  soil  by  drinking. 

The  industrialists  must  be  interested  particularly  in  cases 
of  disability  from  a  functional  neurosis,  that  is  theoretically 


502  THE    KINGDOM    OF   EViLS 

an  always  curable  disease.  The  laundry  worker,  James  Bailty 
(case  7)  was  apparently  saved  from  permanent  disability  due 
to  hysterical  paralysis.     The  cure  was  slow. 

The  roofer's  helper  Lewis  Goldstein  (case  11)  made  a  slow 
recovery  from  an  industrial  accident,  but  there  were  economic 
complications  in  the  Goldstein  case.  The  shipping  clerk  Mark 
White  (case  16)  was  industrially  disabled  from  a  psycho- 
pathic condition  that  dated  back  to  an  accident.  He  was  re- 
stored to  industrial  efficiency  under  social  treatment,  as  was 
also  Hamilton  Green  (case  18).  John  Flynn  (case  19)  was 
one  of  complete  disability  following  traumatic  neurosis.  He 
was  given  work  of  no  great  difficulty — made  slow  improve- 
ment and  after  two  years  was  restored  to  full  efficiency.  The 
machinist  Dennis  O'Donnell  (case  90)  had  a  psychoneurosis 
following  an  industrial  accident.  There  are  a  number  of 
problems  in  the  O'Donnell  case;  owing  to  the  new  economic 
conditions  of  the  war  he  is  able  to  get  higher  wages  in  his  new 
job  than  before. 

David  Collins  (case  42),  the  paretic  machinist,  had  to  have 
money  raised  for  his  treatment  and  his  wife  also  had  to  be 
put  under  treatment.  The  child,  fortunately,  when  examined 
as  to  its  blood  serum,  proved  negative  to  syphilis. 

This  is  not  always  the  case  as  the  special  work  of  H.  C.  and 
M.  H.  Solomon,  working  in  the  Massachusetts  State  Psychia- 
tric Institute,  under  the  Interdepartmental  Social  Hyg'iene 
Board,  has  shown  : 

"Figures  for  the  two  years  1917  and  1918  show  that  the 
social  worker  dealt  with  301  families  of  syphilitics,  of  whom  70 
per  cent  reported  to  the  hospital  for  examination.  In  40  per 
cent  of  the  families  every  memlier  reported.  Among  these 
families  579  individuals  were  desired  for  examination.  Sixty- 
nine  per  cent  were  actually  examined  and  an  additional  10 
per  cent  came  but  were  not  examined  for  special  reasons. 

"As  a  result  of  this  examination  of  families,  much  undis- 
covered syphilis — both  conjugal  and  congenital — is  found.  Of 
394  individuals  examined,  21  per  cent  showed  a  positive  Was- 
sermann  reaction.  Of  those  found  to  need  treatment,  51  per 
cent  were  treated  at  the  hospital  and  40  per  cent  were  referred 
elsewhere  for  treatment."  ^ 

A  very  interesting  and  complicated  case  of  psychoneurosis 
was  the  case  of  the  cigar-maker  David  Stone  (case  24),  who 

'  Maida  H.  Solomon:  "Social  Work  and  Neurosyphilis,"  Social  Hygiene  Quarterly, 
January,    1920. 


THE    KINGDOM    OF    EVILS  503' 

Was  handicapped  by  a  fear  of  open  spaces.  He  has  now  re- 
covered from  this  fear  and  works  regularly  at  good  pay  as  an 
insurance  agent.  Herman  Simonson  (case  27)  also  had  his 
employment  changed.  He  had  a  neurosis  from  which  he  made 
slow  improvement.  He  was  originally  a  clothes-presser  and 
has  now  become  efficient  as  a  porter.  The  plumber  Daniel 
Griffin  (case  34),  unable  to  work  for  six  years  as  a  result  of 
psychoneurosis,  was  treated  for  a  year  and  a  half  and  will  not 
yet  go  out  alone.  He  has  become  far  more  active  about  his 
house  and  hopes  are  entertained  that  he  will  finally  become 
able  to  work  again  at  his  trade.  The  machinist  Ralph  John- 
son (case  71)  was  another  rover  and  was  suicidal.  Under 
treatment  he  has  become  a  steady  workman. 

An  especially  interesting  case  was  that  of  the  architect  Henry 
Allen  (case  100).  Allen  imagined  unfriendly  attitudes  on 
the  part  of  the  employees  and  did  not  want  to  work  in  a  large 
room  full  of  fellow  employees.  He  has  now  found  a  chance 
to  work  by  himself  and  is  doing  well.  The  cigar-maker 
Maurice  Eastman  (case  87)  was  a  neurotic  in  employment 
quite  distasteful  to  him.  With  encouragement  and  occasional 
vacations  he  has  been  kept  at  work  steadily.  A  man  in  the 
liquor  business,  Joseph  Fangillo  (case  89),  had  a  breakdown. 
He  was  gotten  into  the  state  hospital  under  voluntary  com- 
mitment. It  was  his  second  time  in  a  state  hospital.  He  has 
now  recovered  and  has  gone  to  work.  A  typesetter,  Harriet 
Farmer  (case  94),  attempted  suicide.  She  was  at  odds  with 
her  family  and  friends,  was  in  poor  health,  and  was  earning 
low  wages.  Under  treatment  she  became  self-sustaining  and 
has  even  been  advanced  in  her  work. 

We  have  attempted  to  give  in  this  volume  all  the  manifold 
psychiatric  suggestions  that  come  from  industrial  accidents. 
We  conceive  that  industrial  accident  boards  all  over  the  coun- 
try should  make  increasing  use  of  psychiatrists,  expert  medical 
men,  but  especially  of  the  psychiatric  social  worker.  The  In- 
dustrial Accident  Board  of  Massachusetts  has  to  our  knowl- 
edge in  numerous  cases  got  most  important  results  from  such 
social  investigations. 

That  the  high-grade  feeble-minded  person,  or  so-called 
moron,  may  make  a  good  worker  is  shown  in  a  number  of 
cases.  Take  for  instance  the  elevator  operator  Thomas  Fuller 
(case  9).     Fuller  was  even  promoted  to  be  corporal  of  the 


504  THE    KINGDOM    OF    EVILS 

marines  in  war  time.  The  army  authorities  are  not  too  sure 
that  they  want  to  get  rid  of  all  their  morons,  some  of  whom 
may  do  very  good  work  in  menial  tasks  that  the  more  normal 
soldiers  balk  at.  The  moron  Agnes  O'Brien  (case  13)  whose 
trouble  was  complicated  by  hysteria  was  finally  made  self-sup- 
porting in  factory  work.  The  laborer  Rosenthal  (case  49) 
was  another  moron  with  psychoneurotic  complication,  and 
might  in  fact  have  been  figured  amongst  our  accident  cases 
since  his  symptoms  date  chiefly  from  an  accident.  He  is  now 
a  perfectly  steady  and  capable  worker. 

Whilst  writing  this  volume  we  have  heard  of  an  up-to-date 
industrial  firm  that  is  adopting  the  policy  of  establishing  a 
school  for  its  morons.  Such  a  policy  is  to  psychiatrists  en- 
couraging since  it  follows  the  lines  of  Seguin  and  Madame 
Montessori. 

No  doubt  almost  every  employment  manager  would  hesitate 
to  employ  a  known  syphilitic.  Let  us,  however,,  call  attention 
to  Greta  Meyer  (case  40),  a  case  of  cerebrospinal  syphilis ;  that 
is  to  say,  syphilis  affecting  several  parts  of  the  nervous  system 
in  a  more  or  less  diffuse  way.  Mrs.  Meyer,  after  her  improve- 
ment under  medical  treatment  with  salvarsan,  became  a  social 
problem  which  could  actually  be  closed  and  referred  to  the 
voluntary  division  of  the  service  after  a  period  of  a  year. 

Another  syphilitic  case  is  that  of  David  Collins  (case  42), 
a  machinist,  a  victim  of  general  paresis ;  that  is  to  say,  a  dis- 
ease whose  duration  seldom  runs  beyond  three  to  five  years 
from  the  onset  of  symptoms.  Many  social  workers  and  per- 
haps a  majority  of  employment  managers  would  regard  such 
a  man  as  hardly  worth  the  expenditure  of  an  extraordinary 
amount  of  time,  and  no  doubt  more  time  might  well  be  placed 
upon  other  members  of  the  family  than  upon  the  syphilitic. 
Still,  an  examination  of  the  records  of  David  Collins  shows 
that  he  was  made  industrially  competent  and  was  even  pro- 
moted to  a  job  as  foreman.  Consider  also  Harold  Gordon 
(case  46),  a  victim  of  syphilis  in  that  form  which  is  char- 
acterized by  paralysis  on  one  side  of  the  body  due  to  a  de- 
structive lesion  of  the  brain.  The  medical  outlook  for  Gordon 
is  one  of  persistent  paralysis  on  the  side  affected  so  far  as  this 
fails  to  be  improved  by  orthopedic  means  and  by  the  methods 
recommended  by  Dr.  S.  I.  Franz  of  Washington.  Gordon  is 
now  working  regularly  at  his  trade,  that  of  steamfitter.     We 


THE    KINGDOM    OF    EVILS  505 

Single  out  these  three  cases  of  Greta  Meyer,  David  ColHns,  and 
Harold  Gordon  as  illustrative  of  three  of  the  major  groups  of 
syphilitic  diseases  of  the  nervous  system,  each  with  a  different 
outlook  as  to  duration  and  impairment.  Application  of  the 
best  methods  of  social  work  secured  surprisingly  good  results. 

The  jail-bird  group  of  psychopaths  would  doubtless  be 
scouted  as  potential  employees  by  many  employment  managers. 
Plain  jail-birds  might  he  regarded  as  bad  enough;  crazy  ones 
would  be  thought  impossible.  Consider,  however,  the  elevator- 
operator,  Alfred  Stevens  (case  25)  discharged  for  pilfering. 
After  recovery  from  depression  this  elevator-operator  became 
one  of  the  best  employees  in  another  plant.  We  were  also  able 
to  secure  for  Ignatz  Simanski  (case  33),  a  forger,  something 
like  a  good  future.  He  was  a  capable  workman  and  was  gotten 
work  by  us  after  his  discharge  from  the  house  of  correction. 
It  is  to  be  sure  doubtful  whether  Simanski  was  at  all  psycho- 
pathic. Ordinarily  he  might  have  been  handled  by  some  agency 
for  discharged  prisoners.  However,  he  got  into  the  Psycho- 
pathic Hospital's  hands  through  the  suggestion  of  a  layman 
and  on  the  basis  that  he  might  possibly  be  a  victim  of  psycho- 
pathic personality. 

We  are  also  afraid  that  after  approaching  the  matter  from 
a  psychopathic  point  of  view,  most  persons  would  be  disposed 
to  look  with  suspicion  upon  such  a  person  as  the  mill  worker 
Julia  Brown  (case  23),  who  lived  for  so  long  as  a  man. 
Nevertheless  with  proper  measures  of  social  work,  Julia  Brown 
has  become  a  competent  and  trusted  factory  worker.  No  doubt 
her  mental  twist  is  a  profound  one.  "The  inner  relations"  of 
such  a  person  are  hard  to  integrate ;  or  shall  we  say  that  there 
is  integration  of  grotesque  independence  in  Julia  Brown  to  start 
with?  At  all  events  it  has  been  found  possible  to  adjust  the 
"outer  relations"  of  the  environment  in  such  a  manner  that 
this  particular  psychopath  is  getting  on  well.  Almost  equally 
hard  to  deal  with  is  such  a  matter  as  the  fear  of  open  spaces 
exhibited  in  the  cigar-maker  David  Stone  (case  24).  Yet  Stone 
has  recovered  and  is  now  working  regularly  at  good  pay  as  an 
insurance  agent. 

Perhaps  such  interior  difficulties  as  those  of  Michael  Piso 
(case  62)  might  be  regarded  as  still  more  difficult  of  adjust- 
ment. Piso  had  illusions  of  jealousy  that  interfered  with  his 
employment;  but  as  his  jealousy  was  made  to  subside  (or  shall 


506  THE    KINGDOM    OF    EVILS 

we  say,  as  the  jealousy  subsided  of  itself?)  Piso  went  back  to 
work  and  got  his  wages  raised. 

Another  apparently  disconcerting  fact  is  the  long  duration 
of  disability  in  some  cases,  which  seems  to  argue  that  little 
enough  can  ever  be  done.  But  consider  the  case  of  the  plumber 
Daniel  Griffin  (case  34)  who  is  a  psychoneurotic  and  had  actu- 
ally been  unable  to  work  for  six  years.  After  a  year's  treat- 
ment he  has  become  more  active  about  his  home,  although  up 
to  date  he  is  not  willing  to  go  out  alone. 

We  now  turn  to  an  analysis  of  the  family  interests  in  the  in- 
dustrial cases  which  we  have  just  summed  up  from  their  stand- 
points as  individuals.  Certainly  twenty-three  out  of  forty-two 
industrial  cases  of  this  volume  are  cases  with  the  family  prob- 
lem in  sharp  focus. 

Consider  the  case  of  Henry  Loyal  (case  4).  Here  was  the 
family  problem  of  non-support  with  marital  discord.  The 
wife  was  sick;  one  child  had  chorea;  the  second  tuberculosis; 
the  third  required  special  feeding;  one  daughter  was  a  sex 
delinquent.  Every  member  of  the  family  was  an  object  of 
special  attention.  Industrial  rehabilitation  of  Henry  Loyal 
meant  happiness  to  at  least  six  separate  persons.  We  are  in- 
clined to  think  that  the  non-psychiatric  social  worker  would 
have  taken  the  Loyal  family  situation  as  not  particularly  psy- 
chiatric. The  questionnaires  concerning  deserted  families,  got- 
ten out  by  various  social  agencies,  do  not  bring  the  psychiatric 
question  into  sufficient  relief.  It  would  have  been  easy  to  dis- 
miss Henry  Loyal  as  a  "degenerate."  Particularly  Mrs.  Loyal, 
his  wife,  the  sex-delinquent  daughter,  and  the  choreic  child, 
that  is  at  least  four  of  the  six  members  of  the  Loyal  family, 
should  be  more  or  less  constantly  under  psychiatric  review. 

Alfred  Stevens  (case  25),  the  elevator-operator  discharged 
for  pilfering,  had  his  case  complicated  by  the  situation  reverse 
to  that  of  Henry  Loyal,  since  Stevens'  wife  left  him  taking 
their  child,  a  child  to  whom  Stevens  was  greatly  devoted.  Upon 
Stevens'  recovery  from  his  depression  the  family  was  reunited. 

Martin  O'Hara  (case  92),  a  loafer,  presented  another  story 
of  family  problem.  He  had  been  recently  married  but  never 
lived  with  his  wife.  He  found  that  she  had  had  an  illegiti- 
mate baby.  The  medical  problem  was  one  of  hysteria  on  the 
part  of  O'Hara.     No  doubt  the  hysteria  was  on  the  basis  of 


THE    KINGDOM    OF    EVILS  507 

psychopathic  personaHty,  from  which  O'Hara  will  not  recover. 
The  problem  of  social  work  will  be  a  chronic  one. 

More  or  less  continuous  financial  aid  had  to  be  granted  in  a 
number  of  cases.  Lewis  Goldstein,  a  roofer's  helper,  during 
his  slow  recovery  from  an  industrial  accident  had  to  be  helped 
and  the  health  of  his  wife  and  children  made  the  whole  situa- 
tion difficult, — practically  difficult,  however  theoretically  simple 
enough. 

The  case  of  John  Flynn  (case  19)  resembles  that  of  Lewis 
Goldstein;  Flynn  required  two  years  of  care  before  he  could 
be  restored  to  full  efficiency  following  his  complete  disability 
from  traumatic  neurosis.  The  Flynn  family  also  had  a  num- 
ber of  sick  children  to  care  for. 

David  Stone  (case  24),  the  cigar-maker  who  feared  open 
spaces,  was  also  another  case  not  of  individual  disease  alone, 
since  through  the  process  of  his  becoming  industrially  com- 
petent ran  also  the  problem  of  supporting  Stone's  family  and 
steering  his  wife  through  illness. 

Paul  Ernst  (case  y^^),  the  excellent  salesman  who  had  been 
discharged  alter  a  manic  attack,  had  an  income  decidedly  in- 
sufficient for  his  family.  Assistance  was  given  the  family  in 
the  form  of  clothes  and  vacations  for  the  children.  One  of  the 
nine  Ernst  children  also  had  chorea.  The  social  worker  had  to 
contend  with  Ernst's  rather  natural  worry  about  the  family 
finances. 

Hamilton  Green  was  psychopathic  with  a  mother  to  support 
and  the  Green  family  had  been  in  receipt  of  aid  from  public 
funds.  The  improvement  in  Green's  mental  disease  permitting 
work  regularly  abolished  the  problem  of  public  aid. 

Ignatz  Simanski  (case  33)  showed  in  some  sense  the  oppo- 
site situation  since  he  was  making  financial  demands  upon  his 
sister  who  was  only  able  to  support  herself  with  difficulty. 

The  health  of  the  child  of  the  divorcee  Agnes  O'Brien  (case 
13)  had  to  be  considered  and  the  second  (illegitimate)  child 
had  to  be  provided  for  in  public  custody. 

Nathan  Rosenthal  (case  49),  a  laborer,  was  a  moron  with 
psychoneurotic  symptoms  dating  from  an  accident.  The 
Rosenthal  family  first  came  under  observation  through  the 
examination  of  a  son — another  example  of  the  rather  frequent 
uncovering  of  family  problems  through  the  resort  to  a  mental 


5o8  tHE    ktKGDOM    OF    EVILS 

clinic  of  sottle  psychiatric  case.  The  Rosenthal  family  entirely 
was  put  under  social  care.  Work  was  procured  for  the  father. 
The  mother  was  given  suitable  encouragement.  The  son  was 
placed  under  supervision.  Meantime  the  family  had  an  insuf- 
ficient income. 

Another  special  problem  of  advice  was  offered  by  the  case 
of  Maurice  Eastman  (case  87),  the  cigar-maker  whose  trade 
was  distasteful  to  him.  The  family  problem  proved  a  long 
one.  The  fact  that  the  family  was  inclined  to  maintain  a  high 
standard  of  living  made  the  small  income  seem  more  than 
ordinarily  insufficient.  Aid  with  clothes  was  given.  But  more 
particularly  a  specialized  kind  of  encouragement  and  advice  had 
to  be  given  with  relation  to  the  children's  education.  The  East- 
man family  showed  the  usual  Jewish  ambition  for  the  chil- 
dren's education.  All  the  children  were  bright,  and  there  was 
even  an  indication  of  special  talent  in  one  or  two  thereof.  The 
problem  of  the  right  kind  of  encouragement  for  the  education 
of  a  psychoneurotic  is  a  psychiatric  one.  Of  course  we  may 
say  that  not  even  psychiatrists  find  always  the  right  way  in 
such  a  plight.  Yet,  perhaps  the  psychiatrists  should  have  more 
to  say  in  the  premises  than  some  other  person  exempt  from  any 
knowledge  of  psychoneuroses  whatever. 

That  the  industrial  problem  could  not  be  treated  in  and  for 
itself  successfully  and  that  the  ordinary  non-psychiatric  view 
of  the  family  problem  would  be  decidedly  insufficient  are  points 
illustrated  also  in  a  case  like  that  of  Harold  Gordon  (case  46). 
Here  there  had  been  cohabitation  with  a  woman  probably 
psychopathic. 

Paul  Dawson  (case  78)  separated  from  his  wife,  failed  to 
support  her  and  was  perhaps  a  case  of  dementia  praecox.  He 
had  always  worked  irregularly  and  under  our  care  could  not 
be  got  to  take  a  job.  However,  upon  being  drafted  he  made 
an  allotment  to  his  wife.  Upon  his  discharge  he  went  into  the 
merchant  marine. 

Other  cases  of  family  interest  amongst  the  industrial  group 
are  those  of  Herman  Simonson  (case  2"]^  with  a  wife  and  six 
children  and  wife's  parents  in  Russia  dependent  upon  this 
clothes-presser ;  Nathan  Blumberg  (case  37),  a  case  of  non- 
support  in  financial  difficulty,  confused  about  his  affairs,  sep- 
arated from  his  wife;  John  Logan  (case  58),  the  expert  chem- 
ist whose  wife  was  at  first  afraid  to  live  with  him  but  upon 


THE    KINGDOM    OF    EVILS  509 

advice  and  encouragement  kept  up  the  home ;  Patrick  Nolan,  a 
laborer  whose  family  was  dependent  upon  his  wages  and  who 
was  gotten  to  return  to  work  after  recovery  from  delirium 
tremens;  the  jealous  teamster  Michael  Piso  (case  62),  whose 
family  required  material  aid  and  also  the  care  of  health  of  the 
wife  and  children;  the  paranoid  case  of  George  Stone  (case 
76),  whose  delusions  were  not  severe  enough  to  permit  his 
being  committed  to  a  state  institution  and  who  wandered  about 
not  working  and  threatening  his  wife;  Joseph  Fangillo  (case 
89),  whose  illness  ate  up  his  savings  so  that  his  wife  might 
be  maintained ;  the  industrial-accident  case  of  the  machinist 
Dennis  O'Donnell  (case  90),  where  there  was  an  economic 
problem  of  the  family  and  the  problem  of  advice  to  the  wife. 

We  have  added  up  the  more  striking  problems  amongst  the 
twenty-three  family  cases  in  our  industrial  group  of  forty-two 
and  find  that  no  less  than  eighteen  of  the  twenty-three  cases 
yielded  acute  economic  problems  for  the  family  as  well  as  for 
the  industrially  disabled  patient.  When  the  non-psychiatric 
family  case  worker  approaches  such  a  case  as  a  purely  family 
problem  she  has  unquestionably  in  the  past  been  inclined  to 
regard  the  psychopath  as  an  unfortunate  additional  complica- 
tion. We  submit  that  the  treatment  of  these  family  cases 
with  the  psychopath  as  the  primary  target  of  attack  is  the  ra- 
tional strategy  of  the  present  day.  Nine  of  the  twenty-three 
cases  show  degrees  of  sickness  in  the  wife  or  children.  The 
medical  social  worker  will  no  doubt  give  proper  attention  to 
these  physical  sicknesses ;  and  perhaps  the  medical  social  worker 
from  her  hospital  community  experience  may  exhibit  an  ad- 
vance in  social  attitude  upon  that  of  the  philanthropic  family 
case  worker  of  a  former  generation.  But  here  again  we  are 
inclined  to  say  that  the  data  of  this  book  proved  that  the  stand- 
point of  physical  health,  valuable  as  it  is,  is  very  frequently  not 
the  central  problem.  Let  the  central  problem  of  the  psycho- 
neuroses  or  other  mental  diseases  in  the  father  or  mother  be 
properly  treated  and  the  problems  of  sickness  on  the  part  of  the 
wife  and  children  will  get  solved  upon  comparatively  small 
lines.  But  if  we  try  to  solve  the  problem  of  sickness  of  the 
non-psychopathic  spouse  or  children  upon  a  purely  health  basis 
the  psychopathic  difficulty  in  the  parent  will  be  apt  to  run  on 
indefinitely.  (See  particularly  such  a  case  as  that  of  Henry 
Loyal,   case  4,   or    Nathan    Rosenthal,    case   49,   or    Maurice 


5IO  THE    KINGDOM    OF    EVILS 

Eastman,  case  87.)  There  were  nine  cases  also  of  marital  dis- 
cord. Marital  discord  is  perhaps  a  purely  primary  and  moral 
difficulty,  though  we  are  not  aware  that  any  proper  statistics 
on  this  point  of  marital  discord  with  relation  to  psychopathy 
have  ever  been  collected.  The  point  of  this  volume  largely 
turns  upon  our  considering  every  case  of  social  difficulty  as 
possibly  in  the  first  instance  medical,  and  perhaps  psychopathic. 
This  point,  as  we  repeatedly  insist,  is  not  grounded  upon  sta- 
tistical frequency  of  mental  disease  amongst  cases  of  social 
difficulty ;  we  do  not  feel  that  there  are  anywhere  in  the  world 
proper  statistics  on  this  matter.  Our  point  is  that  every  in- 
stance of  social  difficulty  should  first  or  last  receive  considera- 
tion as  possibly  a  medical  matter.  So  with  these  nine  cases  of 
marital  discord.  In  the  Loyal  (case  4)  family  the  wife  was 
possibly  slightly  psychopathic  although  the  big  problem  of 
non-support  was  unquestionably  grounded  in  the  psychopathic 
personality  of  the  husband  and  father.  Nathan  Blumberg 
(case  37)  was  separated  from  his  wife  after  a  quarrel,  but  we 
do  not  here  find  evidence  of  mental  diseases  on  both  sides  of 
the  family.  The  discord  in  the  case  of  Michael  Piso  (case  62) 
was  unquestionably  due  to  this  teamster's  delusions  rather  than 
to  any  attitude  on  the  part  of  the  wife.  Likewise  with  George 
Stone  (case  76). 

There  were  two  cases  complicated  by  illegitimacy  of  a  child. 
Agnes  O'Brien  (case  13)  had  an  illegitimate  second  child. 
Martin  O'Hara  married  a  wife  with  an  illegitimate  baby. 
Agnes  O'Brien  illustrates  one  problem  of  illegitimacy  in  the 
fact  that  she  was  a  hysterical  moron  whom  we  should  not 
regard  as  too  responsible  for  the  fact  of  illegitimacy.  On  the 
other  hand  the  wife  of  Martin  O'Hara  was  as  far  as  we  know 
not  in  any  sense  psychopathic.  As  with  the  questionnaires  re- 
garding non-support,  so  with  the  questionnaires  regarding 
unmarried  mothers;  we  do  not  find  that  these  questionnaires 
take  sufficiently  into  account  the  possibility  of  feeble-minded - 
ness  on  the  part  of  the  unmarried  mother  or  father.  We  have 
not  the  slightest  doubt  that  the  problem  of  illegitimacy  will 
have  a  flood  of  light  thrown  upon  it  by  intensive  study  from 
the  psychiatric  point  of  view. 

To  sum  up  concerning  the  family  interests  in  the  industrial 
group  of  cases,  we  must  emphasize  the  fact  that  first,  each  in- 
dustrial case  must  be  handled  upon  its  merits  as  a  psychopathic 


THE    KINGDOM    OF    EVILS  5I I 

case ;  second,  the  members  of  the  industrial  psychopath's  family 
must  be  treated  socially  like  the  members  of  any  other  family 
case  group;  third,  the  treatment  of  such  a  family  case  group 
containing  a  psychopath  as  a  central  figure,  should  not  be 
treated  as  a  family  unit  (that  is,  from  the  ordinary  standpoint 
of  the  family  case  worker  dealing  with  the  situation  largely 
from  the  economic  side)  ;  fourth,  the  point  of  view  of  the  ordi- 
nary medical  social  worker  (that  is,  the  point  of  view  which 
takes  into  account  the  physical  health  of  each  member  of  the 
family),  is  an  inadequate  approach,  good  so  far  as  it  goes  but 
missing  the  psychiatric  point.  Cases  of  industrial  disability 
might  well  seem,  even  to  the  educated  layman,  primarily  cases 
for  economic  handling  from  the  standpoint  of  the  so-called 
family  case  work.  Yet  the  educated  layman  who  should  think 
that  this  primarily  could  be  handled  by  financial  aid  alone  would 
fall  far  short  of  the  ideals  of  the  present  day.  Let  us  empha- 
size as  ever  that  both  the  family  case  worker  and  the  medical 
social  worker  do  their  best  as  moral  advisers  in  these  situations. 
But  the  kind  of  moral  advice  they  are  equipped  by  nature  and 
training  to  give  needs  supplementation  by  psychiatric  training 
if  the  best  results  are  to  be  obtained. 

The  moral  advice  given  by  the  worker  untrained  in  the  con- 
trast of  temperament  and  the  peculiarities  of  the  different 
major  forms  of  mental  diseases  and  defects  is  but  too  apt  to 
follow  some  particular  slant  of  the  social  worker's  own  nature 
and  experience.  She  is  but  too  apt  to  try  to  make  the  family 
as  a  whole  and  the  central  psychopathic  figure  conform  to 
some  set  ideal  of  action.  It  is  these  industrial  cases  that  bring 
very  acutely  the  combination  of  diseases,  moral  defect,  and 
economic  disability.  The  formula  of  these  cases  is  rather  apt 
to  be  M.  V.  P.,  to  use  our  abbreviated  terminology.  That  is, 
we  find  in  these  cases  some  examples  of  the  morbi,  some  ex- 
amples of  the  vitia,  and  some  examples  of  the  penuriae  rolled 
in  one. 

Our  complaint  as  to  the  shortcomings  of  the  present-day 
social  work  is  that  too  great  emphasis  may  readily  be  laid  upon 
economic  disabilities  (penuriae).  Furthermore,  even  if  the 
hypothesis  of  disease  (morbi)  is  brought  into  the  foreground 
we  find  that  the  morbi  are  taken  in  a  physical  sense  rather  than 
in  a  mental  sense ;  the  medical  social  worker  is  not  sufficiently  a 
psychiatric  social  worker.     With  respect  to  the  vitia,  our  chief 


512  THE    KINGDOM    OF    EVILS 

complaint  reduces  perhaps  to  the  charge  that  the  non-psychi- 
atrically  trained  person  is  but  too  apt  to  think  that  all  men  con- 
form to  or  fall  short  of  certain  standards  of  morality,  whereas 
the  psychiatrically  trained  person  is  apt  to  see  many  types  of 
moral  shortcoming  following  the  lines  of  temperament  and 
the  psychiatric  worker  suspects  that  there  has  been  too  great 
emphasis  upon  the  uniting  of  moral  standards  in  the  human 
race  as  a  whole. 

All  moralists  admit  that  the  moral  situation  (that  is,  the 
situation  which  considers  good  and  evil,  right  and  wrong) 
involves  voluntary  activity — a  point  handed  down  from  Aris- 
totle. "The  agent  must  know,"  say  Dewey  and  Tufts,  "what 
he  is  about;  he  must  have  some  idea  of  what  he  is  doing;  he 
must  not  be  a  somnambulist,  or  an  imbecile,  or  an  infant." 
They  go  on  to  say  that  such  unformed  or  deformed  personali- 
ties exhibit  voluntary  activities  and  in  moral  activity  they  may 
show  character  or  herein  necessarily  be  viewed  morally.  Now 
this  standpoint  may  be  perfectly  well  chosen  from  the  stand- 
point of  voluntary  moral  life  (we  are  inclined  to  concede  even 
this  point,  to  grant  it  for  the  sake  of  argument),  but  the  stand- 
point is  assuredly  not  well  chosen  if  we  are  trying  to  evaluate 
the  vitia;  that  is,  tell  just  how  far  the  acts  formed  are  immoral 
acts  and  how  far  they  are  the  acts  of  untrained  or  immature 
persons  or  how  far  they  are  actually  psychopathic.  In  short, 
we  feel  that  the  study  of  morals  will  greatly  benefit  from  psy- 
chiatric analyses.  But  this  point  takes  us  far  out  of  the  im- 
mediate range  of  industrial  interest.  The  most  prominent 
difficulties  in  the  handling  of  family  situations  of  industrial 
disability  is  the  tendency  on  the  part  of  persons  without  a 
psychiatric  training  or  experience  to  deal  with  families  upon  a 
purely  economic  basis  or  upon  a  basis  of  mere  physical  health. 

OUT-PATIENT   SERVICE 

Some  patients  resort  upon  their  own  initiative  to  the  out- 
patient service  (for  example,  Ethel  Murphy,  case  66,  and 
Jeanette  Burroughs,  case  68)  and  are  then,  if  desirable,  readily 
persuaded  to  enter  the  hospital  wards.  William  Donahue 
(case  82)  came  of  his  own  initiative  to  the  out-patient  depart- 
ment and  never  seemed  to  need  treatment  in  the  wards. 
Maurice  Eastman  (case  87)  was  treated  as  an  out-patient  only 


THE    KINGDOM    OF    EVILS  513 

by  psychotherapeutic  means.  And  though  Eastman's  troubles 
seemed  to  require  at  least  three  types  of  worker  and  much 
individualization,  yet  ward  treatment  never  came  in  question. 
Louis  Sand  (case  95),  the  roving  Belgian  immigrant,  re- 
mained also  an  out-patient  case  throughout  a  long  and  rather 
intensive  social  treatment. 

Shall  mental  treatment  be  carried  out  in  hospital  beds  or 
in  the  out-patient  department?  Many  states  still  possess  no 
means  of  treating  mental  cases  in  adequate  out-patient  depart- 
ments, such  as  those  provided  for  example  by  Massachusetts 
and  New  York.  Yet  the  establishment  of  such  out-patient  de- 
partments should  be  easily  brought  about  in  forward-looking 
states,  since  it  must  be  apparent  to  the  most  fiscally-minded 
legislators  that  out-patient  departments  are  cheaper  to  run 
than  hospital  wards.  It  is  obvious  that  many  patients  can 
be  got  in  for  out-patient  examinations  who  would  not  readily 
consent  to  come  even  as  voluntary  patients  who  stay  in  beds. 
The  values  of  out-patient  department  work  are  shown  in  the 
majority  of  our  cases,  first  from  analysis  of  their  reports 
thereto  through  the  follow-up  work  after  they  have  been  re- 
leased from  the  wards.  But  a  number  of  cases  are  particularly 
interesting  from  the  standpoint  of  the  values  of  the  out-patient 
department  mental  examination.  Consider  Bessie  Silver- 
man (case  21).  This  Jewess  came  herself  upon  her  own 
recognizance  to  the  out-patient  department  of  the  hospital  to 
find  out  the  degree  of  her  mental  capacity.  Bessie,  it  will  be 
remembered,  was  that  case  of  disharmony  between  ambition 
and  ability  who  was  bent  upon  somehow  going  through  college. 

Emma  Marburg  (case  30)  came  to  the  out-patient  depart- 
ment through  the  advice  of  another  patient.  She  was  unable 
to  hold  out  any  longer  on  account  of  her  fatigue  and  worry. 

Some  cases  are  treated  with  success  as  out-patients  only; 
compare  Beatrice  Cellini  (case  52),  who  came  of  a  family 
known  to  at  least  twenty-four  social  agencies.  The  diagnosis 
in  the  Cellini  case  could  be  rendered  with  apparent  safety  with- 
out resorting  to  the  hospital  wards. 

We  may  properly  use  these  cases  to  prove  the  independent 
value  of  out-patient  services  and  dispensaries  for  mental  cases. 
Yet,  we  must  not  forget  that  where  an  out-patient  service  is  a 
departmental  service  and  lodged  in  an  imposing  hospital  struc- 
ture surrounded  by  evidences  of  intensive  medical,  educational, 


514  THE    KINGDOM    OF    EVILS 

social,  psychological,  occupational,  and  nursing  work,  the 
effects  gained  are  not  purely  those  of  the  out-patient  service 
per  se.  The  out-patient  service  in  this  sense  is  under  the  aus- 
pices of  something  big,  complex,  almost  sacred,  ever  in  the 
eye  of  the  patient  as  a  vista  of  resources  for  help. 

We  have  spoken  of  imposing  structures.  The  state  hospital 
structures  whether  of  the  Bastile  type  or  of  the  more  modern 
scattered  cottage  description  (sometimes,  we  regret  to  say, 
like  a  lot  of  small  Bastiles!)  will  no  doubt  ever  remain  forbid- 
ding to  certain  types  of  mind  in  difficulty,  which  will  be  entirely 
willing  to  visit  the  out-patient  department  of  a  psychopathic 
hospital  or  the  consulting  room  of  a  mental  hygiene  society. 
These  values  are  very  delicate  ones  to  estimate.  The  consult- 
ing office  specialist  cannot  quite  see  how  his  type  of  patient 
could  willingly  resort  to  any  form  of  out-patient  department, 
if  he  could  possibly  get  the  money  to  resort  to  a  private  medi- 
cal consulting  office. 

Yet  there  are  certain  types  of  men  and  women  that  seem 
to  abhor  private  consulting  offices  and  much  prefer  public  con- 
tacts. Again  there  is  a  certain  class  of  persons  who  are  effec- 
tively drawn  under  observation  by  the  state  and  local  mental 
hygiene  societies  whose  rooms  are  found  in  office  buildings  and 
may  be  resorted  to  without  fear  of  observation  at  the  door  or 
in  the  corridors.  Another  type  of  patient  is  drawn  to  the 
modern  psychopathic  hospital  divorced  in  construction  and  in  its 
practical  associations  from  the  district  state  institution.  The 
Psychopathic  Hospital  in  Boston  has  without  artificial  stimulus 
an  out-patient  department  that  usually  runs  to  the  number  of 
fifteen  hundred  per  annum.  It  would  be  entirely  impossible, 
we  venture  to  say,  for  any  district  institution  primarily  for  the 
committable  insane  to  show  such  a  record — a  record  partly 
founded  in  the  public  recognition  of  especially  trained  physi- 
cians, psychologists,  and  social  workers  to  be  found  therein, 
but  more  effectively  still  in  the  good  effects  advertised  from 
neighbor  to  neighbor  as  shown  by  returning  patients.  We 
doubt  whether  any  institution  not  primarily  constructed  for  the 
voluntary  class  of  patients  and  for  the  so-called  temporary  care 
group  of  non-committable  patients,  will  ever  draw  from  the 
community  so  important  and  extensive  a  group  of  out-patients. 

The  scope  of  this  work  does  not  include  a  special  discussion 
of  methods  of  psychotherapy.     We  give  upon  another  page 


THE    KINGDOM    OF    EVILS  515 

the  main  methods  of  psychotherapy  mentioned  in  textbooks  (a 
list  drawn  from  Shell-Shock  and  Other  Neuropsychiatric 
Problems,  1919,  by  the  senior  author).  The  adjustment  of 
man  to  himself  is  not  primarily  a  function  of  social  work 
and  we  are  prepared  to  admit  that  there  are  numerous  cases 
of  complete  adjustment  of  man  to  himself  altogether  outside 
the  field  of  social  work.  The  works  of  Janet  are  filled  with 
instances  of  such  interior  adjustment  by  the  psychotherapeu- 
tists.    We  may  call  attention  to  several  cases  in  our  group. 

Daniel  Griffin  (case  34)  was  a  case  in  which  there  were 
many  psychogenic  factors;  that  is,  factors  of  mental  diseases 
that  took  their  rise  from  troubles  inside  the  patient's  own  mind. 
This  was  the  case  of  the  man  who  did  not  work  and  never  went 
out  in  the  daytime  for  a  period  of  about  six  years.  A  psycho- 
therapy by  persuasion  was  adopted.  Another  instance  of  this 
is  that  of  Louis  Sand  (case  95).  And  Maurice  Eastman  (case 
87)  should  be  carefully  reread  by  the  reader  interested  in  psy- 
chotherapy. This  man  had  been  coached  by  physicians  to 
know  that  his  disease  was  "all  foolishness" — an  instance  in 
which  psychotherapy  may  defeat  itself.  He  was  given  a  sort 
of  talking  cure  by  a  psychologist  in  the  Psychopathic  Hospital 
and  was  made  to  read  popular  works  of  psychotherapy.  We 
shall  not  repeat  the  remarks  under  this  case  concerning  the  fact 
that  psychiatric  social  work  is  not  psychotherapeutic  in  the  full 
sense  of  the  term  (at  all  events  not  in  the  medical  sense  of  the 
term),  and  is  decidedly  not  competent  to  decide  upon  the  re- 
spective values  of  the  different  forms  of  psychotherapy  listed 
in  the  chart  (page  481),  especially  upon  the  values  of  such 
methods  of  psychotherapy  as  hypnosis  and  psychoanalysis. 
The  spheres  of  influence  of  the  psychiatric  social  worker  as  of 
any  social  worker  are  decidedly  not  either  the  public  or  the 
personal  spheres.  The  social  worker  cannot  take  the  place  of 
the  judge  or  public  administrator  and  must  not  feel  irked  by 
her  inability  to  act  as  a  substitute  for  the  public  servants.  As 
we  have  repeatedly  said,  she  must  use  the  public  service  as  ful- 
crum. But  it  is  even  more  true,  though  perhaps  less  obvious, 
that  the  psychiatric  social  worker  cannot  replace  the  physician 
in  the  most  intimate  and  personal  matters  of  treatment. 

The  reason  why  this  is  not  too  obvious  to  every  psychiatric 
social  worker  is  that  everybody  is  aware  that  the  methods  of 
psychotherapy  grade  very  gently  over  into  methods  of  convic- 


5l6  THE    KINGDOM    OF    EVILS 

tion  and  persuasion,  in  short  of  suggestion,  as  employed  in 
everyday  life.  Every  father  or  mother,  brother  or  sister — 
everybody  who  has  served  in  any  dominant  way  in  relation  to 
some  human  being — is  aware  of  his  or  her  suggestive  powers. 
It  is  very  natural  therefore  for  the  psychiatric  social  worker 
to  fall  victim  to  the  belief  that  she  might  solve  the  problems  of 
suggestion  in  her  psychopathic  patients  as  well  as  the  physician. 
She  knows  that  she  can  in  fact  exert  certain  suggestive  powers 
under  certain  conditions  of  time  and  place  that  the  physician 
can  exert.  She -has  in  mind  certain  successes  in  conviction  or 
persuasion  as  exerted  upon  given  cases  in  her  experience.  Yet 
mutual  adaptation  of  the  interior  relations  of  the  mind  to  one 
another  under  psychopathic  circumstances  is  not  at  all  easy. 
Suggestion  is  easy  but  the  right  suggestion  is  difficult ;  when  we 
examine  the  life  histories  of  certain  patients  we  find  them  a 
succession  of  layers  of  suggestions  like  the  layers  of  paint  in 
certafn  ancient  canvases.  Universally  the  human  mind  is  a  lit- 
tle more  like  water-color  painting  than  one  in  oils,  so  that'  it  is 
often  impossible  to  eradicate  the  earlier  impressions  by  fresh 
ones.  Armed  with  new  knowledge  about  suggestion  and  plied 
with  the  histories  of  successful  adaptation  by  psychotherapeu- 
tic means,  the  youthful  social  worker  may  be  inclined  to  enter 
where  the  psychotherapeutist  would  hardly  dare  to  tread. 

Is  it  wiser  to  let  the  public  service  adjust  its  own  environ- 
mental services,  gradually  molded  into  proper  shape  by  improve- 
ment in  communal  opinion,  and  to  let  the  specialist  in  psycho- 
therapy pursue  his  own  difficult  course  of  the  mutual  adjust- 
ment of  inner  relations  without  undue  interference  by  the 
social  worker?  To  be  sure  communal  opinion  about  improve- 
ments in  the  public  service  will  never  acquire  greater  strength 
than  when  supported  by  the  concrete  facts  supplied  by  the  ex- 
perienced social  worker.  By  the  same  token  the  psychothera- 
peutist may  be  unable  to  make  his  weighty  decisions  (whether 
he  or  she  act  by  conviction  or  persuasion,  terrorism  or  the  vel- 
vet glove,  hypnotism  or  psychoanalysis)  only  in  virtue  of  some 
little  special  indication  that  the  social  observer  has  recorded. 


PSYCHIATRIC  SOCIAL  WORK 

HISTORY 

In  the  development  of  a  new  profession,  from  time  to  time 
new  interests  come  to  the  front,  dominate  the  scene  for  a  while, 
and  gradually  become  assimilated  into  the  body  of  experience. 
A  new  branch  remains  upon  the  main  trunk,  and  at  the  same 
time  the  parent  stem  is  strengthened.  This  process  is  the  cur- 
rent history  of  psychiatric  social  work.  In  the  multiform  ac- 
tivities of  social  work,  gradually  taking  shape  in  a  new  pro- 
fession, there  are  found  many  traces  of  interest  in  mind  as  a 
primary  factor  in  social  life, — the  keynote  principle  of  psychi- 
atric social  work.  St.  Vincent  de  Paul's  efforts  to  relieve  the 
sick  poor,  among  the  earliest  attempts  at  organized  social  work, 
had  for  their  object  "to  teach  the  poor  to  be  provident  for 
themselves,"  as  well  as  "to  point  out  to  them  sources  of  em- 
ployment." Cicero  considered  the  mental  effect  of  alms  :  "We 
must  take  care  that  our  bounty  is  a  real  blessing  to  those  we 
relieve,  that  the  claims  of  gratitude  and  justice  are  preferred 
to  mere  compassion,  and  that  due  regard  is  given  both  to  the 
character  and  the  wants  of  the  recipient." 

The  aim  of  all  modern  social  work  has  been  to  build  up  char- 
acter. Nevertheless,  until  recently,  there  has  been  no  system- 
atic attempt  to  study  character  by  exact  methods.  Social 
work  has  not  heretofore  attempted  to  apply  the  mental  sciences 
to  understanding  of  the  individual.  "Common-sense"  methods 
have  been  relied  upon  in  estimating  personality,  and  "trial-and- 
error"  methods  in  solving  mental  problems.  While  the  world 
is  far  from  possessing  a  science  of  character,  there  is  a  certain 
amount  of  .knowledge  derived  from  the  mental  sciences,  psy- 
chology and  psychopathology,  that  can  be  applied  to  advantage 
in  dealing  with  human  beings.  Even  a  small  amount  of  sci- 
entific knowledge  may  afford  a  large  amount  of  practical 
value.  The  benefit  to  the  individual,  whose  difficulties  are 
better  understood  by  reason  of  some  bit  of  science,  may  be 
incalculable. 

517 


5l8  THE    KINGDOM    OF    EVILS 

This  new  branch  of  social  work  known  as  psychiatric  social 
work  is  a  new  emphasis  rather  than  a  new  function.  It  has 
grown  out  of  ideas  and  activities  that  already  existed  in  scat- 
tered forms.  A  similar  situation  is  found  in  the  development 
of  medical  social  work  during  the  last  fifteen  years.  The  new 
emphasis  upon  attention  to  disease  and  care  of  health  spread 
rapidly  in  general  social  work,  until  now  the  idea  of  using 
scientific  methods  to  maintain  health  is  part  of  the  equipment 
of  every  well-trained  social  worker.  Theory,  to  be  sure,  is 
ahead  of  practice,  as  it  must  always  be,  and  social  work  has 
far  to  go  before  it  can  be  said  to  be  making  the  best  use  of 
medical  science;  but  the  principle  of  a  medical  point  of  view 
is  established. 

At  first  social  work  was  dominated  by  the  economis  point  of 
view.  Economic  features  of  social  disorder  are  most  con- 
spicuous (food  and  shelter  are  the  first  obvious  needs),  and 
therefore  receive  first  attention.  Moreover,  the  social  worker's 
special  contribution  to  social  problems  is  knowledge  of  the 
environment  (the  social  worker  is  a  specialist  in  environment), 
and  here  also  the  outstanding  features  are  economic.  Again, 
the  origin  of  systematized  social  work  in  "poor  relief"  put  eco- 
nomic considerations  in  the  lead.  But  just  as  the  medical  point 
of  view  came  to  the  front  and  was  assimilated,  so  at  the  present 
time  the  psychiatric  point  of  view  is  in  the  foreground  and  is 
in  process  of  being  absorbed  into  the  movement. 

The  history  of  psychiatric  social  work  is  the  focusing  of 
various  recent  influences  leading  to  more  attention  to  the 
mind  in  social  practice,  under  pressure  from  psychiatry 
demanding  more  attention  to  social  needs  in  medical  prac- 
tice. In  social  work,  among  these  trends,  one  that  stands  out 
prominently  is  the  increasing  insistence  of  the  family  welfare 
group  upon  better  understanding  of  motives  and  more  exact 
methods  of  arousing  interest  and  purpose.  In  the  children's 
agencies,  there  has  been  growing  a  sense  of  the  need  of  apply- 
ing child  psychology  in  the  education  of  young  wards.  Agencies 
caring  for  the  unmarried  mother  have  come  to  recognize  the 
primary  importance  of  mental  conditions  in  these  cases.  Psy- 
chiatric clinics  established  in  connection  with  courts  (of  which 
Dr.  Healy's  clinic  in  the  Chicago  juvenile  court  was  the  fore- 
runner), and  in  connection  with  prisons  and  reformatories 
(such  as  the  clinic  started  by  Dr.  Glueck  at  Sing  Sing  prison), 


THE    KINGDOM    OF    EVILS  519 

have  given  impetus  to  the  psychiatric  interest  in  social  work. 
From  medical  social  work  came  another  influence  in  the  insist- 
ence of  Dr.  Cabot  that  social  work  was  essentially  the  develop- 
ment of  character  under  adversity. 

In  medicine  many  definite  trends  may  be  seen  that  have 
contributed  to  the  present  development  of  psychiatric  social 
work.  A  very  explicit  statement  of  the  need  of  social  work 
in  the  practice  of  psychiatry  w^as  made  twenty  years  ago  by 
Dr.  Theodore  H.  Kellogg,  superintendent  of  a  hospital  for 
mental  diseases,  in  his  Textbook  on  Mental  Diseases:  "In- 
sanity practically  is  loss  of  the  power  of  conformity  to  the 
social  medium  in  which  the  patient  lives.  This  power  is  re- 
gained in  convalescence  gradually,  and  it  is  a  part  of  psycho- 
therapy to  furnish  a  normal  personal  environment  to  which  the 
patient  is  to  practice  adjustment;"  and  again:  "The  physician 
who  has  conducted  a  case  of  mental  disorder  through  all  the 
vicissitudes  of  an  acute  attack  to  perfect  recovery  has  a  final 
duty  to  perform.  There  are  to  be  laid  down  definite  rules  of 
life,  points  in  physical  and  mental  hygiene,  suggestions  of  the 
best  way  to  meet  social  and  business  difficulties,  and  advice  as 
to  domestic  relations."  It  was  some  fifteen  years  later  that 
systematic  provision  began  to  be  made  for  seeing  that  these 
"rules  of  life"  laid  down  by  the  physician  were  actually  fol- 
lowed by  the  patient.  It  was  thought  that  the  physician  could 
perform  this  function  of  social  readjustment  and  many  hospital 
superintendents  and  physicians  did  so  to  the  best  of  their  abil- 
ity. Others  were  beginning  to  see  the  possibility  of  specially 
trained  lay  workers  for  this  purpose. 

Meanwhile  psychiatrists  were  coming  into  closer  association 
with  social  workers.  It  is  of  some  interest  that  at  the  first 
meeting  of  the  National  Conference  of  Social  Work  (then  the 
Conference  of  Charities  and  Correction),  in  1874,  the  first 
subject  considered  was  "The  Duty  of  the  States  toward  Their 
Insane  Poor,"  in  a  paper  by  a  state-hospital  superintendent: 
and  the  subject  of  "insanity"  figured  largely  in  the  programs 
of  the  early  years.  A  section  on  feeble-mindedness  and  insan- 
ity was  created  and  in  191 7  became  the  mental-hygiene  section. 
Another  medical  influence,  which  no  doubt  gave  considerable 
impetus  to  the  development  of  psychiatric  social  work,  was  the 
growing  appreciation  of  physicians  in  general  hospitals  of  the 
value  of  the  social  service,  and  the  experience  of  psychiatrists 


520  THE    KINGDOM    OF    EVILS 

in  mental  clinics  of  these  hospitals  that  the  assistance  of  social 
workers  became  indispensable. 

The  chronology  of  psychiatric  social  work  down  its  main 
line  of  development,  social  care  for  cases  of  mental  disease, 
begins  with  the  Society  for  the  After-Care  of  the  Insane  in 
England,  which  as  early  as  1880  was  engaged  in  giving  friendly 
supervision  to  patients  discharged  from  hospitals.  The  first 
attempt  in  this  country  to  employ  social  work  in  the  care  of 
patients  with  nervous  and  mental  disorders  seems  to  have  been 
in  the  Neurological  Clinic  of  the  Massachusetts  General  Hos- 
pital in  Boston  in  1905,  when  Dr.  James  J.  Putnam,  who  was 
in  charge  of  the  clinic,  secured  the  assistance  of  a  social  worker, 
Miss  Edith  N.  Burleigh,  and  personally  trained  her  for  the 
work.  A  year  later  a  social  worker  was  placed  in  the  psycho- 
pathic wards  of  Bellevue  Hospital,  New  York.  The  New  York 
State  Charities  Aid  Association  was  a  leading  influence  in  de- 
veloping this  field  through  its  Committee  on  Mental  Hygiene, 
which  in  1910  appointed  an  "after-care  worker"  to  supervise  pa- 
tients discharged  from  two  of  the  state  hospitals  of  New  York. 
The  first  social  worker  to  be  placed  upon  the  payroll  of  a  state 
hospital  for  mental  diseases  was  employed  through  the  influ- 
ence of  this  Committee  in  1911,  by  the  Manhattan  State  Hos- 
pital, New  York,  where  she  had  previously  been  engaged  upon 
salary  paid  by  the  Committee.  Two  years  later,  1913,  two 
Massachusetts  hospitals,  Danvers  State  Hospital  and  Boston 
State  Hospital,  each  added  a  social  worker  to  the  staff. 

The  same  year  the  Psychopathic  Hospital  began  to  organize 
its  social  service.  Although  the  original  plans  provided  for  a 
social  service,  the  work  was  not  regularly  started  until  a  year 
after  the  hospital  was  opened.  The  ideas  of  the  Director  con- 
cerning the  introduction  of  this  new  agency  into  the  institution 
are  expressed  in  some  notes  written  a  year  or  two  later : — 

"The  social  service  movement  seems  to  be  waxing  fast,  al- 
though not  fast  enough  for  its  problems.  Personally  I  seem  to 
have  been  greatly  influenced  by  some  of  Professor  Royce's 
earlier  ethical  papers  touching  the  social  'consciousness'  so- 
called,  by  Professor  Putnam's  contentions,  and  by  the  point  of 
view  of  Professor  James  which  culminated  in  his  marvelous 
address  on  The  Moral  Equivalent  of  War.  Then  came  brief 
but  uplifting  observations  of  the  Social  Service  Department  of 
the   Massachusetts   General   Hospital   under  the   leadership   of 


THE    KINGDOM    OF    EVILS  521 

Miss  Ida  M.  Cannon.  After  the  establishment  of  the  Psycho- 
pathic Hospital,  I  began  to  get  light  from  a  group  of  persons 
interested  in  social  service,  among  whom,  besides  Miss  Cannon, 
I  should  especially  count  my  colleague  Dr.  W.  P.  Lucas,  Mr. 
Michael  M.  Davis,  and  Miss  Katherine  McMahon. 

"My  own  ideas  are  derived  from  many  sources.  The  need 
of  a  social  service  in  the  new  Psychopathic  Hospital  became 
obvious  at  once  when  the  plans  were  tentativel}'  begun  in  1909- 
1910  and  the  obvious  need  was  expressed  in  so  many  words  in 
the  State  Board  of  Insanity's  report  of  1910.  So  far  as  I  can 
remember,  space  was  reserved  for  social  service  in  the  very 
first  of  the  plans  from  which  the  eventual  plan  was  developed. 
To  be  sure,  many  physicians  who  were  shown  the  plans  af- 
fected astonishment  at  the  large  space  assigned  to  the  out- 
patient work  as  a  whole,  and  there  was  almost  no  general 
appreciation  of  either  the  whole  out-patient  work  or  its  social 
service  constituents.  These  critics  are  now  easily  won  over 
by  the  practical  results  obtained." 

We  claim  no  novelty  or  originality  for  the  social  work  of 
the  Psychopathic  Hospital,  but  rather,  we  would  claim  to  have 
created  the  part  that  the  social  worker  is  to  play  in  the 
mental  hygiene  movement  and  to  have  given  it  a  name — 
psychiatric  social  work.  The  bases  of  this  new  division  of 
social  work  are  the  principles  common  to  all  forms  of  social 
case  work.  It  is  the  application  of  old  methods  in  a  new  field. 
It  will,  we  expect,  develop  some  new  methods,  which  will  in 
time  be  applied  in  the  older  fields.  In  the  new  field  there  was 
need  of  bringing  to  a  focus  existing  trends,  of  defining  func- 
tions, outlining  requirements  of  special  training,  and  giving 
the  whole  a  distinctive  name. 

The  Great  War  had  an  important  influence  upon  the  spread 
of  psychiatric  social  w^ork.  It  was  clear  to  those  who  had  seen 
the  importance  of  social  service  in  civilian  hospitals  that  psy- 
chiatric social  workers  would  be  needed  for  army  hospitals. 
But  there  w^ere  only  a  handful  of  social  workers  with  this  spe- 
cial training  in  the  whole  country.  Plans  to  enlarge  the  capac- 
ity of  the  training  course  at  the  Psychopathic  Hospital  were 
proceeding  when  it  was  found  possible  to  combine  with  Smith 
College  in  a  course,  given  in  191 8- 191 9,  under  the  auspices  of 
a  committee  of  the  National  Committee  for  Mental  Hygiene. 
Similar  courses,  conceived  as  emergency  measures  or  as  per- 
manent developments  of  the  curriculum,  were  offered  by  other 


522  THE    KINGDOM    OF    EVILS 

schools  in  New  York,  Philadelphia,  and  Chicago,  In  Canada 
a  similar  course  was  given  at  Toronto  University.  Fifty-odd 
graduates  of  the  Smith  College  course  went  into  army  hospitals 
or  Red  Cross  organizations.  The  pioneer  piece  of  psychiatric 
social  work  in  the  army  was  done  in  the  neuro-psychiatric  hos- 
pital at  Plattsburg,  b}'  Miss  Margherita  Ryther,  who  had 
been  for  some  years  social  worker  in  the  Neurological  Clinic 
of  the  Massachusetts  General  Hospital,  Boston.  The  need  for , 
social  service  in  any  program  for  adequate  care  of  neuropsy- 
chiatric  cases  among  soldiers  was  demonstrated.  This  princi- 
ple established  in  the  army  hospitals  has  carried  over  into  the 
public  health  hospitals.  The  Red  Cross  in  connection  with  the 
public  health  service  and  the  Veterans'  Bureau  are  now  en- 
deavoring to  develop  a  complete  organization  of  psychiatric 
social  work  for  the  care  of  ex-service  men  with  neuropsychiat- 
ric  disabilities. 

The  effect  of  psychiatric  social  work  upon  general  social 
work  came  into  focus  in  a  surprising  way  at  the  National  Con- 
ference of  Social  Work  in  Atlantic  City  in  May,  1919.  There 
was  suddenly  a  realization  in  many  quarters  that  psychiatry's 
contribution  to  general  social  work  ought  to  be  made  available. 
Dr.  Cabot  spoke  of  the  new  force,  "new,  not  in  name,  but  in 
efficiency  and  energy — which  has  come  into  social  work — the 
force  represented  by  psychiatric  social  work.  In  thirty  years  I 
have  never  seen  anything  so  important  as  the  irruption  of  psy- 
chiatric social  work  into  social  work."  The  idea  is  now  widely 
accepted  that  social  case  work  calls  for  psychiatric  knowledge 
and  the  psychiatric  point  of  view.  It  remains  to  find  ways  and 
means  to  enable  social  workers  at  large  to  get  what  psychiatry 
can  offer.  A  number  of  means  are  at  hand, — the  best  perhaps 
are  the  summer  courses  in  social  psychiatry  offered  by  certain 
schools  of  social  work.  Evening  courses  may  be  arranged. 
Brief  extension  courses  as  an  introduction  to  the  subject  are 
offered  by  some  schools,  with  clinics  to  demonstrate  types  of 
mental  disorder.  Reading  help^,  but  the  literature  of  social 
psychiatry  is  mostly  in  the  form  of  detached  articles.  In  Bos- 
ton, a  group  of  twenty-five  executives  of  social  agencies  and 
leading  social  workers  formed  a  class  to  study  with  a  psychia- 
trist, who  was  familiar  with  their  field,  the  best  means  of  ap- 
plying psychiatry  in  social  work. 

To  avoid  confusion  of  terms,  it  may  be  well  to  state  here 


THE    KINGDOM    OF    EVILS  523 

that  "social  psychiatry"  is  not  used  as  an  alternate  for  "psy- 
chiatric social  ivork."  Psychiatric  social  work  is  the  special 
form  of  social  work  in  which  psychiatric  knowledge  is  particu- 
larly required.  Social  psychiatry  is  an  art  now  in  the  course 
of  development  by  which  the  psychiatrist  deals  with  social  prob- 
lems. Social  psychiatry  is  a  branch  of  psychiatry  and  a  special 
kind  of  medical  art.  That  part  of  the  knowledge  of  psychiatry 
which  has  a  bearing  upon  social  problems  is  given  to  social 
workers  in  courses  named  social  psychiatry, — that  is,  the  es- 
sentials of  psychiatry  from  the  standpoint  of  social  work.  The 
special  preparation  of  the  psychiatric  social  worker  should 
consist  not  only  of  courses  in  social  psychiatry  but  also  of  prac- 
tice in  social  work  with  psychiatric  cases.  The  inclusive  term 
mental  hygiene  is  used  to  cover  the  activities  of  psychiatrist, 
psychologist,  the  psychiatric  social  worker  in  promoting  mental 
health  wheresoever. 

ORGANIZATION    AND    FUNCTIONS    OF    THE    SOCIAL    SERVICE    AT 
THE   BOSTON    PSYCHOPATHIC    HOSPITAL 

Some  account  of  the  development  and  organization  of  the 
social  service  of  the  Psychopathic  Hospital  may  be  suggestive 
to  similar  departments  in  process  of  formation.  Any  scheme 
of  organization  is  a  growth  determined  largely  by  local  condi- 
tions, and  therefore  may  not  be  suitable  to  transplant.  There 
are,  however,  some  fundamental  principles  and  practices  com- 
mon to  all  similar  institutions,  in  regard  to  which  experiences 
may  be  exchanged  with  profit.  The  psychopathic  hospital  and 
the  state  hospital  for  mental  diseases  will  differ  in  the  organiza- 
tion of  their  social  service  as  well  as  of  their  medical  service; 
but  both  types  of  hospital  will  have  common  features  in  both 
medical  and  social  work.  This  account  is  by  no  means  intended 
to  present  a  model  form  of  organization.  The  system  here 
developed,  however,  works  on  the  whole  with  reasonable  effec- 
tiveness, and  most  of  its  fundamental  principles  and  chief  de- 
vices we  would  recommend  with  confidence. 

The  question  of  the  proper  organization  of  the  social  service 
depends  fundamentally  upon  whether  a  hospital  is  regarded  as 
a  community  institution,  in  which  medical  and  social  depart- 
ments cooperate,  or  as  a  medical  institution  controlled  and  di- 
rected by  physicians  with  social  assistants.     This  question  of 


524  THE    KINGDOM    OF    EVILS 

organization  arises  irrespective  of  the  question  of  functional 
control  and  direction  of  social  work  in  a  hospital.  Besides  the 
question  of  immediate  direction  (or  supervision)  of  the  social 
worker's  activities,  there  is  a  question  of  the  right  administra- 
tive relation  between  medical  work  and  social  work.  The 
position  taken  by  a  particular  hospital  on  this  point  affects  the 
development  of  its  social  service  in  both  frank  and  subtle  ways. 
A  confused  policy  on  this  point  leads  to  misunderstandings 
and  retardation  of  the  work  of  the  social  service. 

At  the  present  time  most  of  our  hospitals  are  acknowledged 
medical  institutions,  primarily  for  the  treatment  and  study  of 
disease,  and  they  are  administered  by  medical  men.  Therefore 
the  social  work  should  properly  be  subordinated  to  the  medical 
work,  the  physician  employing  social  assistants  and  relying 
upon  their  special  skill  (without  attempt  to  direct  a  form  of 
practice  in  which  he  is  not  trained)  to  promote  the  medical 
work.  As  the  horizons  of  medicine  widen,  it  is  conceivable 
that  the  hospital  of  the  future  may  be  a  social  institution,  ad- 
ministered by  men  of  sociological-medical  training.  The  com- 
mimity  no  doubt  will  more  and  more  demand  that  the  hospital 
treat  the  whole  man,  that  the  treatment  of  disease  aim  at  com- 
plete social  adjustment,  and  that  the  hospital  go  outside  its  walls 
to  prevent  disease. 

At  the  Psychopathic  Hospital  the  social  service  was  organ- 
ized to  assist  in  the  medical  work  of  studying  and  treating  men- 
tal disease.  Its  function  of  assisting  in  treatment  was  con- 
strued in  the  broadest  sense  to  mean  (a)  restoration  of  capac- 
ity for  normal  living,  or  (b)  provision  for  greatest  possible 
comfort.  The  out-patient  department  and  the  social  service 
have  developed  with  close  interrelations.  While  many  social- 
service  cases  first  receive  attention  on  the  wards,  the  greater 
part  of  the  work  is  of  course  with  patients  in  the  community. 
The  medical  and  social  aspects  of  out-patient  treatment  for 
nervous  and  mental  disorders  are  so  closely  interwoven  that 
they  can  hardly  be  discussed  separately.  An  occasional  case 
may  be  free  from  social  complications  and  call  for  treatment  by 
the  physician  only.  Also,  in  an  occasional  case  the  physician 
may  find  that  the  root  of  the  difficulty  is  social  and  may  leave 
the  case  in  the  hands  of  the  social  worker.  In  most  cases, 
medical  treatment  is  supplemented  and  reinforced  by  social 
care.     The  efforts  of  the  social  worker  in  such  cases  must, 


THE    KINGDOM    OF    EVILS  525 

of  course,  be  definitely  designed  to  contribute  to  medical  treat- 
ment. 

For  the  best  results,  social  work  should  be  immediately  under 
social  direction,  but  the  practice  of  the  social  worker  in  every 
case  must  be  strictly  in  accordance  with  the  doctor's  ideas  for 
the  patient;  and  if  in  any  case  a  conflict  of  social  and  medical 
interests  arise,  the  medical  decision  obviously  must  prevail; 
since  the  treatment  of  a  mentally  sick  person  is  primarily  a 
medical  problem.  This  relation  between  medical  and  social 
work  is  sometimes  not  understood  by  observers,  who  see  the 
large  amount  of  responsibility  borne  by  the  social  worker  in 
certain  cases  that  the  physician  sees  infrequently,  and  who  do 
not  realize  that  the  physician  has  delegated  responsibility  to  the 
social  worker  to  carry  out  social  treatment  in  conformity  with 
the  medical  plan. 

A  routine  social  examination  for  all  admissions  was  our  ulti- 
mate aim,^  but  was  impossible  with  the  number  of  social 
workers  available.  Therefore  the  expedient  was  adopted  of 
relying  upon  the  physicians  to  report  cases  in  which  social  work 
was  required.  About  one-fourth  of  the  cases  referred  by 
physicians  are  likely  to  be  cases  where  a  history  is  required 
for  medical  diagnosis,  but  social  care  is  not  required.  (See  cases 
54  and  72.)  The  physician  is  apt  to  look  upon  this  function  of 
the  social  service  as  its  most  important  duty,  since  his  primary 
responsibility  to  the  patient  is  to  endeavor  to  make  a  correct 
diagnosis.  In  a  sense  it  is  also  the  primary  responsibility  of 
the  social  worker  to  contribute  to  this  object,  which  is  the 
hospital's  first  duty  to  the  patient.  Equally  important  to  the 
social  worker,  in  addition,  is  the  welfare  of  the  patient  in  the 
community.  Moreover,  the  benefit  of  careful  diagnosis  can  be 
secured  in  many  cases  only  by  painstaking,  thorough  social 
care.  The  social  worker,  engaged  in  social  treatment,  is  bound 
to  feel  a  sense  of  interruption  if  histories  for  medical  diagnosis 
cause  deferred  attention  to  social  cases.  The  success  of  social 
treatment  may  depend  upon  timeliness,  steadiness,  persistence, 
or  close  application;  and  emergencies  continually  arise  when 
least  expected.  No  matter  how  thoroughly  the  social  worker 
recognizes  the  importance  of  the  medical-social  history,  she 
cannot  feel  the  same  enthusiasm  that  the  physician  would  feel 

^  From  Annual  Report  of  the  Director,  Psychopathic  Department,  Boston  State 
Hospital,  191 5:  "Of  course  with  a  properly  increased  staff,  we  should  like  to  secure 
a  social  examination  for  every  patient  on  admission." 


526  THE    KINGDOM    OF   EVILS 

in  devoting  a  day's  work  to  it,  while  perhaps  neglecting  work 
that  is  her  own  immediate  responsibility.  This  is  especially 
likely  to  be  true  if  the  significance  of  the  history  turns  upon 
some  fine  medical  point.  Therefore  it  might  be  more  effective 
to  have  certain  social  workers  give  their  time  wholly  to  getting 
medical-social  histories. 

Individual  case  work  is  the  nucleus  of  the  department.  Since 
it  was  impossible  to  treat  all  cases  with  thoroughness,  on  ac- 
count of  an  insufficient  number  of  workers,  a  distinction  was 
adopted  between  "intensive"'  and  "slight  service"  cases  based 
upon  the  degree  of  responsibility  for  social  care  assumed  by 
the  department.  In  the  intensive  cases  the  social  service  at- 
tempts to  assume  responsibility  for  making  a  full  inquiry  into 
the  social  condition  of  the  patient  and  his  family  and  endeavors 
to  secure  the  largest  measure  of  social  well-being  possible  for 
both  patient  and  family.  The  "slight  service"  cases  are  those 
in  which  assistance  is  given  without  inquiry  beyond  the  appar- 
ent facts  or  responsibility  beyond  the  immediate  service.  (For 
examples  of  slight  service  cases,  see  cases  39,  41,  and  67.) 

An  attempt  was  made  to  estimate  the  staff  of  social  workers 
needed  to  cover  the  case  work.  There  is  no  direct  precedent  or 
definite  standard  for  determining  how  many  cases  one  social 
worker  in  a  psychopathic  hospital  can  carry,  but  by  a  compari- 
son of  the  experience  of  the  Committee  on  Mental  Hygiene 
of  the  New  York  State  Charities  Aid  Association  and  that  of 
other  agencies  doing  somewhat  similar  work,  it  was  estimated 
that  one  social  worker  could  take  in  a  year  one  hundred  and 
fifty  cases  for  investigation  and  miscellaneous  services  or  could 
care  for  about  fifty  patients  a  year  under  supervision  (that  is, 
ten  under  treatment  at  one  time  for  an  average  period  of  three 
months  each),  so  that  a  social  worker  engaged  in  both  inves- 
tigation and  supervision  would  average  one  hundred  cases  a 
year. 

Not  every  patient  will  require  the  care  of  the  social  service. 
In  a  city  with  well-developed  social  agencies,  about  twenty-five 
per  cent  of  admissions  may  be  already  in  the  care  of  other 
social  workers,  and  about  twenty-five  per  cent  of  the  patients 
appear  not  to  require  social  care,  the  majority  being  patients 
committed  to  hospitals,  who  have  no  one  dependent  upon  them 
or  whose  families  have  already  become  adjusted  to  their  men- 
tal condition.    Others  have  families  able  and  intelligent  enough 


THE    KINGDOM    OF    EVILS  52/ 

to  do  for  them  all  that  can  be  done ;  a  few  are  unmarried  per- 
sons who  habitually  wander,  so  that  it  is  impossible  to  keep  in 
communication  with  them.  So'  it  is  possible  to  estimate  roughly 
that  for  every  two  hundred  admissions  a  social  worker  will  be 
required  for  individual  case  work.  The  additional  functions 
of  research  and  teaching  will  call  for  additional  workers. 

The  expense  of  the  social  service  of  a  psychopathic  hospital 
considered  from  the  standpoint  of  efficient  hospital  administra- 
tion (with  the  object  of  restoring  patients  to  competency  as  far 
as  possible)  has  yet  to  be  carefully  estimated.  We  have  a  few 
notions  on  the  matter.  (See  also  case  71.)  The  saving  of 
expense  to  the  state  in  the  prevention  of  crimes  by  psychopathic 
individuals  through  social  supervision  cannot  be  calculated ;  but 
special  instances  indicate  that  it  may  be  considerable.  Through 
the  care  of  social  workers  many  patients  who  would  become  a 
charge  upon  the  state  are  kept  at  home,  either  self-supporting 
or  maintained  by  relatives.  During  our  first  two  years'  work 
at  the  Psychopathic  Hospital,  twenty  patients,  who  by  all  indi- 
cations would  otherwise  have  required  institutional  care,  were 
kept  in  the  community  through  the  activities  of  the  social  serv- 
ice. Averaged  at  a  saving  to  the  state  of  one  year's  main- 
tenance each,  these  cases  showed  a  saving  of  $5,200  which  was 
more  than  the  amount  paid  by  the  state  in  salaries  to  our  social 
workers  during  that  period.  As  three  of  these  patients,  who 
were  insane,  were  returned  to  relatives  in  their  native  countries, 
the  state  was  probably  saved  in  their  cases  many  years'  support. 
So  that,  in  relation  to  the  state  treasury,  the  department  was 
then  more  than  paying  for  itself. 

In  systematizing  the  case  work,  the  social  service  borrowed 
a  number  of  devices  from  the  organization  of  the  medical  serv- 
ice, when  Dr.  Herman  M.  Adler  was  -chief  of  staff.  Workers 
and  students  are  divided  into  "groups"  (the  "head  of  the 
group"  being  the  most  experienced  worker  on  that  duty),  and 
cases  as  referred  are  assigned  in  rotation  to  the  groups,  record 
being  made  on  a  "rotation  sheet"  The  head  of  the  group  is 
responsible  for  assigning  the  case  within  her  group  in  the  best 
way  to  get  the  work  done  promptly  and  well.  A  worker  (or 
advanced  student)  is  assigned  each  day  to  duty  as  "visitor  for 
the  day"  to  receive  inquiries  and  deal  with  emergencies  and  to 
attend  to  certain  routine  duties.  The  whole  staff  meet  every 
morning  for  the  first  half  hour  for  discussion  of  cases.     On 


528  THE   KINGDOM    OF   EVILS 

the  fourth  day  after  assignment  new  cases  are  presented  in 
summary  with  an  analysis  of  "social  symptoms"  so-called  (fac- 
tors of  social  maladjustment)  indicated  so  far  as  it  has  been 
possible  to  carry  the  investigation.  Results  of  social  treatment 
are  reported  every  three  months  at  the  "morning  discussion." 

A  method  of  giving  each  case  worker  a  "daily  reminder"  of 
her  work  for  the  day  has  been  found  serviceable.  An  explana- 
tion of  this  method  and  a  sample  of  the  card  that  the  social 
worker  receives  each  day  are  here  given. 


August  15, 

1916 

H.  A. 

I  day  case 

George  Brown 

4    «       « 

Beulah  King 

14    "       " 

John  Sheehan 

I  month  case 

Grace  Haskell 
Bessie  Snow 

3       "         " 

James  Johnson 
Ada  Jones 

Records  up  to 

date 

Explanation:  Cards  are  to  be  marked  witli  a  check  after  the  patient's 
name  if  the  work  has  been  done,  and  returned  at  the  end  of  the  day  to 
the  stenographer.  If  the  work  has  not  been  done,  the  name  will  be  carried 
forward  onto  the  card  of  the  following  day  with  the  number  of  days  over- 
due indicated. 

I  day  case,  twenty-four  hours  after  assignment. — Preliminary  examina- 
tion to  be  made,  including  interview  with  examining  physician. 

4  day  case,  fourth  day  after  assignment. — To  be  presented  at  morning 
discussion. 

14  day  case. — Investigation  to  be  completed.  (If  an  intensive  case,  sum- 
mary to  be  completed.) 

I  month  case. — Status  to  be  reconsidered  (whether  case  should  be  closed 
or  should  be  continued  for  advice  and  supervision). 

3  month  case. — Summary  of  results  to  be  made. 

15th  of  each  month  records  to  be  brought  up  to  date. 

30th  of  each  month  monthly  statistics  to  be  made  up. 

A  procedure  for  the  work  upon  a  new  case  has  been  devel- 
oped as  follows : 

a.  Case  assigned  by  recommendation  slip. 

b.  Assignment  noted  on  rotation  sheet. 

c.  Memorandum  slip  filled  out  (see  Appendix  B,  Form  I). 

d.  Examining  physician  seen. 


THE    KINGDOM    OF    EVILS  529 

e.    Patient's  story  obtained  by  interview. 

/.     Registration  slip  made. 

g.    Entry  made  on  visitor's  monthly  statistical  sheet. 

h.     Case  folder  made. 

i.     Inquiry  slip  filled  out  (see  Appendix  B,  Form  II). 

y.     Decision  whether  to  be  dealt  with  as  "intensive"  or  "slight  service" 

case   made   within   twenty-four   hours    if   possible.     Otherwise   case 

registered    as    "slight   service,"    and    later    if    desirable    changed    to 

"intensive." 
k.     Record  folder  made  out  on  fourth  day  (for  intensive  cases;  records 

of  slight  service  cases  kept  in  form  of  "Notes"  only). 
/.      Case  presented  at  morning  discussion  on  fourth  day. 

The  memorandum  slip  is  for  rough  notes  taken  from  the 
medical  record  or  obtained  from  the  patient  for  use  in  the  in- 
vestigation. It  is  taken  along  on  visits  and  filed  on  return  to 
the  office  in  the  folder  for  the  case;  so  that  even  before  the 
record  is  written  there  will  be  some  identifying  information  in 
the  folder.  After  the  information  contained  on  the  memoran- 
dum slip  has  been  copied  into  the  record,  the  slip  is  destroyed. 
The  inquiry  slip  is  for  the  purpose  of  laying  out  a  plan  of  in- 
vestigation. As  soon  as  all  clues  immediately  obtainable  are  in 
hand,  the  informants  to  be  interviewed  by  visit  or  telephone  or 
to  be  written  to  are  listed.  Others  may  be  added  later  on,  or 
the  original  plan  may  be  altered.  The  inquiry  slip  is  taken 
along  on  visits  and  filed  in  the  case-folder  on  return.  It  is 
destroyed  when  the  investigation  has  been  completed. 

The  interview  with  the  patient  before  any  steps  in  investiga- 
tion are  taken  is  considered  important.  In  addition  to  the 
information  obtained  by  the  doctor,  the  social  worker  needs 
certain  sociological  data  for  the  purposes  of  investigation,  such 
as  (a)  exact  names  and  addresses  of  relatives,  employers, 
neighbors,  teachers,  clergymen,  friends,  who  are  possible  in- 
formants;  (b)  resources  among  relatives  and  friends  that  may 
be  a  help  in  social  readjustment ;  (c)  details  about  the  home  and 
neighborhood:  (d)  exact  knowledge  of  all  the  members  of  the 
family  group  and  other  close  associates;  (e)  the  patient's  atti- 
tude toward  his  family  and  his  idea  of  their  attitude  toward 
him;  (/)  the  ratio  between  income  and  expenditures,  and  the 
relation  between  income  and  standard  of  living;  (g)  the  pa- 
tient's tastes  in  regard  to  employment,  recreation,  occupation 
in  leisure  time;  (h)  what  relatives  or  friends  have  most  influ- 
ence with  him;  (i)  his  own  plans  for  the  future. 

From  the  beginning  of  the  department  it  was  considered 


530  THE    KINGDOM    OF    EVILS 

important  to  differentiate  clearly  between  the  various  functions 
of  the  social  service.  Even  when  different  parts  of  the  work 
must  be  performed  by  the  same  person,  because  of  an  inade- 
quate staff,  it  is  desirable  to  keep  different  forms  of  work 
clearly  separate,  so  that  each  may  receive  its  due  share  of  atten- 
tion and  may  be  in  line  for  expansion.  After  individual  case 
work,  the  first  duty  of  the  social  service  that  stood  out  was 
assistance  in  the  out-patient  clinic,  and  the  first  assistant  se- 
cured was  the  clinic  manager,  whose  duties  are  : — 

Executive: 

a.  To  direct  patients  to  the  examiners  during  the  clinic. 

b.  To  keep  in  order  the  records. 

c.  To  keep  statistics. 

d.  To  see  that  reports  of  examinations  are  sent  to  social  agen- 
cies. 

Social: 

a.  To  take  the  social  history  of  new  patients. 

b.  To  assist  in  discovering  and  dealing  with  the  social  prob- 
lems of  out-patients. 

c.  To    see   that   patients    and    friends    with   them    understand 
physician's  directions  and  are  able  to  carry  them  out. 

d.  To  act  as  a  go-between  for  outside  social  workers  and  the 
physicians. 

Among  other  divisions  of  the  social  service  developed  as  the 
opportunity  arose  is  the  follow-up  service,^  a  routine  method 
of  keeping  informed  by  a  card  system  of  the  failure  of  patients 
to  keep  their  appointments  and  inducing  them  by  letter,  tele- 
phone, or  visit  to  report.  This  work,  besides  its  clerical  as- 
pects, has  been  found  to  require  fine  judgment  and  the  point  of 
view  of  a  social  worker,  and  to  show  good  results  in  so  far  as 
these  factors  are  present  in  the  worker  in  charge. 

The  syphilis  service  "  was  developed  as  a  routine  system  for 
keeping  syphilitic  patients  under  treatment  and  securing  exam- 
ination of  their  relatives.  Here  skill  and  judgment  are  obvi- 
ously required  in  suggesting  to  relatives  apparently  healthy  in 
most  instances  a  blood  test  for  syphilis.  Of  579  persons  for 
whom  examination  was  sought  in  the  years  191 7  and  1918,  69 

»  Boston  State  Hospital,  Annual  Report  1917 — Report  of  Director,  Psychopathic 
Department — Follow-up  Service  by  Dorothy  Q.  Hale,  pp.  S3-S7- 

=  The  same — Social  Work  with  Syphilitics  and  Their  Families,  by  Maida  H.  Solo- 
mon, pp.  S7-65- 


THE    KINGDOM    OF    EVILS  531 

per  cent  were  examined;  and  of  these  21  per  cent  required 
treatment  (see  cases  41  and  45). 

The  Men's  Club,  started  at  the  suggestion  of  Dr.  A.  Warren 
Stearns  as  a  means  of  therapy  for  alcohoHc  patients  (see  cases 
6,  58,  and  71),  proved  to  be  an  effective  aid  in  social  treatment 
for  men  patients  with  the  habit  of  alcohoHsm. 

The  aim  of  research  has  been  kept  in  view  and  as  far  as 
possible  material  (records,  statistics)  has  been  gathered 
with  a  view  to  possible  use  in  the  future  in  medical  and  social 
investigations. 

A  study  of  the  psychopathic  employee  in  industry,  begun  in 
19 14,  was  continued  until  1920,  through  a  special  social  worker 
to  assist  men  patients  with  difficulties  of  industrial  adaptation, 
and  led  to  an  investigation  in  the  mental  hygiene  of  industry 
conducted  by  the  Engineering  Foundation  of  New  York.  (See 
also  page  499.) 

The  principle  has  been  maintained  that  the  search  for  new 
truth  concerning  human  beings  rests  at  bottom  upon  careful 
study  of  the  individual  in  action.  Research  and  assistance  to 
the  individual  in  social  work  are  two  aspects  of  the  same  mat- 
ter. This  seems  to  be  a  truism  too  simple  to  require  statement ; 
but  research  has  become  associated  with  laboratory  experi- 
ments in  the  minds  of  some  persons,  to  such  a  degree  that  they 
are  apt  to  lose  sight  of  the  human  value  to  individual  patients 
of  social  case  work  that  is  done  with  the  ultimate  object  of 
research. 

Plans  for  special  research  in  methods  of  social  case  work 
were  interrupted  by  the  war.  Studies  of  technique  of  social 
investigation  and  treatment  by  the  most  thoughtful  and  experi- 
enced social  workers  to  be  found  are  clearly  the  next  step  in  the 
development  of  scientific  methods  in  case  work.  The  psychiat- 
ric social  service  affords  unusually  favorable  conditions  for 
such  study, — with  psychologist  and  psychiatrist  at  hand  to  give 
their  aid,  which  is  indispensable.  Moreover,  traits  of  human 
nature  are  more  conspicuous  and  therefore  more  readily  studied 
in  psychopathic  patients.  Just  as  principles  of  education  were 
discovered  through  teaching  the  feeble-minded,  so  we  may 
look  for  principles  of  social  work  to  be  found  in  case  work 
with  psychopaths. 

The  department  was  organized  from  the  start  to  permit  the 
traming  of  stitdents,  for  we  felt  a  responsibility  to  prepare  new 


532  THE    KINGDOM    OF    EVILS 

workers  for  this  field.  As  none  of  the  schools  of  social  work 
had  yet  developed  training  courses  in  psychiatric  social  work, 
we  offered  an  apprenticeship  course  in  which  the  student  gave 
full  time  for  six  months.  The  term  was  later  increased  to 
eight  months,  as  six  months  was  found  insufficient  for  acquir- 
ing even  the  rudiments  of  social  work  and  social  psychiatry. 
Several  attempts  were  made  to  take  students  on  part  time  for  a 
longer  period,  but  this  plan  was  unsatisfactory,  for  the  inter- 
ruptions in  the  students'  work  increased  the  difficulties  of 
organization  to  such  an  extent  that  part-time  students  became 
more  of  a  burden  than  a  help.  From  the  students'  point  of 
view,  it  was  apparent  that  they  received  much  less  benefit 
from  part-time  work  than  from  an  equal  number  of  days'  work 
on  full  time.  The  full-time  student  is  an  asset,  taking  her 
share  in  routine  duties  and  after  a  few  months  giving  valuable 
assistance  in  the  case  work.  The  presence  of  students  in  the 
daily  morning  discussion  adds  greatly  to  the  value  of  these 
conferences.  The  alert,  inquiring  attitude  of  the  student  is 
stimulating,  and  the  necessity  for  being  definite  and  clear 
enough  to  be  understood  by  the  beginner  helps  to  keep  the  more 
experienced  workers  in  perpetual  training. 

Another  function  of  the  social  service  from  the  beginning 
has  been  public  education — to  promote  understanding  of  men- 
tal disease  and  to  reduce  prejudice  against  mental  hospitals,  and 
particularly  to  help  social  workers  acquire  the  essentials  of 
psychiatry.  Social  workers  were  encouraged  to  seek  from  the 
physicians  an  explanation  of  the  patient's  condition  and  needs 
in  every  case  brought  by  them  for  examination.  In  order  to 
make  sure  that  a  correct  statement  of  the  examination  was  filed 
with  the  case  record  in  the  agency  which  had  responsibility  for 
the  patient's  care,  this  verbal  report  was  supplemented  by  a 
routine  written  report  consisting  of  brief  summaries  of  the 
physical  and  mental  examinations  and  intelligence  tests.  Some 
social  workers  came  to  depend  upon  this  report  without  con- 
sulting the  medical  or  social  workers  of  the  hospital,  although 
the  brief  summary  of  medical  findings  furnished  them  was 
not  sufficient  in  most  cases  to  serve  as  a  guide  to  social 
treatment. 

The  social  worker  would  like  a  written  report  giving  a  full 
exposition  of  the  case, — the  character  of  the  difficulty,  the 
prognosis,  and  practical  measures  of  treatment.     Such  a  re- 


THE    KINGDOM    OF   EVILS  533 

port,  however,  seems  to  be  so  complete  that  there  is  still  more 
danger  that  the  social  worker  will  rely  upon  it  entirely  without 
further  consultation.  And  there  is  danger  that  misleading 
or  superficial  conclusions  may  be  drawn  from  any  written  re- 
port alone.  Moreover,  the  time  required  for  a  physician  to 
write  a  careful  explanation  of  the  case,  adapted  to  the  under- 
standing of  the  particular  type  of  social  worker  to  whom  it  is 
to  go,  is  prohibitive  in  most  clinics  and  hospitals.  The  time 
required  for  a  stenographer  to  make  a  transcript  from  the 
medical  record  is  another  matter.  It  is  true  that  in  the  present 
state  of  education  for  social  work,  a  report  expressed  in  med- 
ical terms  will  not  be  understood  by  all  social  workers;  but 
in  every  case  the  worker  responsible  has  the  opportunity  to 
find  out  the  meaning  of  the  medical  report.  On  the  whole,  the 
method  of  furnishing  a  transcript  from  the  medical  record 
and  requiring  a  personal  consultation  has  seemed  best  calcu- 
lated to  secure  the  interests  of  the  patients. 

Social  clinics  have  been  held  every  year,  sometimes  for  a 
particular  group  (the  Boston  Conference  on  Illegitimacy,  a 
Red  Cross  Institute,  classes  taking  extension  courses  in  social 
psychiatry  at  the  Boston  School  of  Social  Work)  and  some- 
times for  social  workers  at  large.  A  series  of  clinics  for  em- 
ployment managers  was  also  given.  The  history  and  the 
actual  patient  are,  as  a  rule,  both  introduced.  Patients  suitable 
for  demonstration  are  carefully  chosen  with  an  eye  to  seeing 
that  the  patients  do  not  themselves  suffer.  In  the  majority 
of  instances  the  patients  are  actually  helped  by  the  clinic,  in 
that  they  are  made  to  see  the  nature  of  the  problems  which 
they  present,  and  yet  are  not  overborne  by  the  legal  authority 
which  a  court  appearance  would  assert.  Some  of  the  most 
instructive  cases,  from  the  standpoint  of  diagnosis  and  dis- 
position, are  in  fact  cases  of  delinquency  or  suspected  delin- 
quency, in  which  the  clinical  demonstration  is  far  less  of  an 
ordeal  than  would  be  an  appearance  in  court.  As  a  rule,  from 
forty  to  sixty  social  workers  have  appeared  at  the  social  clinics 
so  far  carried  on.  Amongst  these  workers  will  appear,  as  a 
rule,  persons  greatly  sympathetic  with  the  patient,  and  the 
"third  degree"  aspect  of  the  meetings  is  reduced  to  practically 
nil.  To  many  patients,  instead  of  being  a  severe  ordeal,  the 
experience  is  rather  agreeable.  In  many  cases  it  is  really 
beneficial  to  the  patient  who  is  forced  by  the  interest  of  so 


534  THE    KINGDOM    OF    EVILS 

many  persons  to  confront  his  own  mental  difficulties  ana  »« 
put  on  his  mettle  to  do  the  best  he  can  to  overcome  his  limita- 
tions. At  a  clinic  for  employment  managers,  one  patient  suffer- 
ing from  a  persistent  traumatic  neurosis,  John  Flynn  (case 
19),  was  presented  and  apparently  enjoyed  the  meeting.  A 
few  weeks  later  he  sent  several  of  his  themes,  part  of  an  eve- 
ning course  in  English  that  he  was  taking  at  the  Trade  Union 
College,  for  the  physician  whom  he  had  met  on  that  occasion 
to  see,  confident  that  he  had  a  new  friend  in  the  doctor. 

SOCIAL    CASE    RECORDS 

Most  existing  record  forms  in  social  agencies  are  admitted 
by  everybody  concerned  to  be  unsatisfactory,  either  because 
they  do  not  contain  the  material  they  should  or  because  the 
material  they  contain  is  not  readily  accessible.  Notwithstand- 
ing abundant  discussion,  very  little  work  has  been  done  on 
improved  methods  of  social  case-recording.  The  only  avail- 
able studies  of  the  subject  are  the  work  of  Miss  Georgia  G. 
Ralph,  Elements  of  Record  Keeping  for  Child-Helping  Or- 
ganizations  and  recent  books  by  Mrs.  Ada  D.  Sheffield,  The 
Social  Case  History:  Its  Construction  and  Contents,  and  by 
Miss  Gertrude  L.  Farmer,  A  Form  of  Record  for  Hospital 
Social  Work. 

The  stage  at  which  a  life  history  was  recorded  by  means  of 
a  printed  form  seems  to  have  passed.  Most  agencies  now  have 
an  outline  of  facts  adapted  to  the  particular  needs  of  their  work 
to  serve  as  a  guide  in  recording  the  social  examination.  Prob- 
ably no  record  system  could  be  devised  that  would  meet  fully 
the  needs  of  all  agencies.  Within  the  same  agency  it  may 
appear  economical  to  use  a  different  form  of  recording  for 
"slight  service"  and  "intensive"  cases.  As  a  rule  the  record 
of  a  "slight  service"  case  reduces  itself  to  a  brief  memorandum 
on  an  index  card  or  a  record  sheet.  It  is  in  the  cases  where 
responsibility  is  assumed  for  a  complete  history  and  thorough 
treatment  that  the  record  problem  arises. 

While  the  same  form  will  not  meet  the  needs  of  all  sorts  of 
social  agencies,  it  might  seem  that  the  main  outline  of  the 
facts  to  be  secured  would  be  the  same  in  any  case  whatsoever 
under  social  care.  The  records  of  different  agencies  would 
vary  in  the  details  of  some  of  the  subheadings  of  such  a  gen- 
eral outline.     The  children's  agency  would  be  likely  to  go  into 


THE    KINGDOM    OF    EVILS  535 

more  detail  concerning  the  developmental  history  of  a  particu- 
lar child  than  the  family  agency  would  need  to;  the  society 
for  protecting  neglected  children  would  require  details  of  evi- 
dence not  essential  to  the  work  of  other  children's  agencies; 
in  a  medical  social  service  certain  items  of  bodily  condition 
not  significant  for  the  general  agency  might  be  needed ;  certain 
details  of  mental  states  bearing  upon  the  mental  diagnosis 
would  be  found  only  in  the  records  of  the  psychiatric  social 
service.  In  general  the  social  service  of  a  psychopathic  hos- 
pital requires  for  its  work  just  such  a  record  as  would  be 
needed  by  a  children's  agency,  the  parole  department  of  a 
reformatory,  or  a  family  agency  (in  individual  cases).  With 
certain  modifications,  a  standard  history  outline  for  all  social 
records  might  prove  very  serviceable.  It  must  always  be  borne 
in  mind,  however,  that  the  value  of  the  record  depends  not 
upon  the  outline  but  on  knowledge  of  what  facts  are  significant 
and  on  skill  in  obtaining  information.  Given,  however,  a 
skillful  and  intelligent  social  worker,  a  good  history  outline 
as  a  framework  for  investigation  is  a  helpful  support.  With 
beginners  and  less  reliable  workers,  it  is  an  essential. 

In  considering  social  case-recording  we  are  of  course  think- 
ing of  the  history  of  an  individual.  The  so-called  "family 
record"  is  another  thing, — there  is  the  story  of  the  family  life 
to  be  written.  But  each  member  of  the  family  has  his  own 
individual  history,  which  has  a  claim  to  be  separately  recorded. 
Each  member  of  the  family  must  be  studied  separately  in 
order  to  understand  the  family  group.  And  for  study  of  the 
individuals  of  the  group,  individual  histories  are  required.  If 
information  concerning  the  different  members  of  the  family 
is  not  sorted  out  and  recorded  separately,  the  effect  of  the 
record  will  be  very  much  like  a  composite  photograph.  There 
will  be  a  hint  of  this  or  that  individual  member  of  the  group, 
but  no  clear  picture.  To  individualize  each  member  of  the 
family,  it  would  seem  to  be  essential  to  record  his  history  sepa- 
rately. Certain  facts  that  relate  to  all  members  of  the  family 
might  be  referred  to  by  cross  reference  in  order  to  save  space 
and  time.  The  family  case  worker  would  perhaps  object  that 
in  the  process  of  making  individual  records  the  story  of  the 
family  group  life  would  tend  to  get  lost.  It  may  be  that  a 
summary  of  the  fofivily  would  meet  this  need.  We  have  no 
claim  to  offer  a  solution  for  any  of  the  perplexities  of  record- 


536  THE    KINGDOM    OF    EVILS 

keeping, — we  aim  here  only  to  emphasize  individuahzation  in 
social  case  work. 

There  is  hardly  a  question  anywhere  today  as  to  whether 
social  records  should  be  or  not  be, — the  case  is  proved  that 
good  records  help  to  make  good  work.  Yet  the  relative  value 
of  a  good  record  system  is  indistinctly  seen;  and  many  agen- 
cies question  the  proportion  of  time  that  it  pays  to  give  to 
record-keeping.  This  depends  first  of  all  upon  the  purposes 
that  the  record  serves — the  ways  in  which  it  promotes  the  wel- 
fare of  the  patient  or  client. 

The  immediate  purposes  of  the  record  are  to  make  the  his- 
tory  available  for  use  (by  physicians,  as  well  as  social  workers) 
in  a  hospital;  to  save  reinvestigation  if  the  case  is  renewed 
after  being  closed ;  to  enable  a  new  worker  who  must  take  up 
the  case  to  understand  the  situation;  and  to  oblige  the  worker 
to  think  clearly  and  to  make  her  work  definite.  Social  records 
serve  also  the  ultimate  purposes  of  furnishing  material  in  ac- 
cessible form  for  social  and  medical  research ;  making  it  pos- 
sible to  study  the  work  of  the  agency  and  estimate  its 
performance;  furnishing  standards  for  bringing  the  work  of 
other  agencies  to  a  higher  level ;  and  affording  material  for 
teaching  students.  » 

The  necessary  documents  of  the  record  we  have  found  to  be : 

a.  A  brief  first  sheet  giving  identifying  information  and  facts 
needed  for  statistics  (see  Appendix  B,  Form  I). 

h.  History  (record  of  the  investigation  or  social  examination; 
for  outline  see  Appendix  B,  Form  II). 

c.  Treatment  (record  of  the  action  taken,  the  current  history 
of  the  case  under  social  care). 

d.  Summary  of  history. 

e.  Summaries  of  treatment  and  results  at  regular  intervals  and 
when  the  case  is  closed. 

/.    Address  sheet  for  addresses  in  current  use. 

g.    Financial  sheet  for  expenditures  or  special  donations. 

h.    Correspondence  arranged  chronologically. 

Examples  of  full  records  of  cases  46,  89,  94  are  given  in 
Appendix  A;  examples  of  "Summary"  will  be  found  in  cases 
20,  24,  32;  and  examples  of  "Results"  will  be  found  in  cases 
31  and  62.  The  summary  of  the  history  is  prepared  under 
the  divisions  of  social,  physical,  and  mental  history,  and  re- 
sults are  summarized  every  three  months  in  the  same  manner. 


THE    KINGDOM    OF    EVILS  537 

In  the  discussions  of  social  workers  there  seems  to  be  an  un- 
certainty of  opinion  as  to  the  nature  and  uses  of  a  summary. 
Some  look  to  it  for  a  full  presentation  of  the  case,  a  complete 
digest  of  the  history,  which  is  recorded  elsewhere  in  the  form 
of  interviews  and  letters.  We  conceive  the  summary  as  the 
briefest  possible  statement  of  the  essential  facts  of  the  case, 
following  in  form  the  outline  used  for  collecting  the  data.  The 
judgment  of  the  worker  in  selecting  the  essential  facts  neces- 
sarily enters  into  the  summary.  A  thorough  consideration  of 
a  case  cannot  be  based  upon  a  summary  alone.  In  our  case 
conferences  the  summary  is  supplemented  by  comments  and 
questions.  There  have  been  certain  attempts  to  adapt  the  five- 
fold classification  of  the  Kingdom  of  Evils  to  the  purpose  of  the 
summary  by  using  the  positive  aspects  of  the  evils  there  com- 
prised as  headings  for  a  summary,  but  this  is  a  mistake;  for 
the  fivefold  classification  is  far  from  being  a  scheme  for  the 
collection  of  data  but  is  proposed  as  an  orderly  method  of 
case  analysis.  The  summary  is  a  synthesis  of  the  case,  in- 
tended to  present  a  vivid  picture  of  the  main  outlines  of  the 
individual's  history. 

One  of  the  chief  difficulties  in  studying  methods  and  results 
in  social  treatment  is  the  lack  of  information  in  the  record 
concerning  the  plans  and  purposes  of  the  social  worker.  It  is 
usually  impossible  to  form  any  idea  of  what  the  patient  owes 
to  social  care  and  what  to  "nature."  The  technique  of  treat- 
ment can  rarely  be  discovered  from  the  record.  There  may 
or  may  not  have  been  a  method  in  the  treatment,  as  far  as  the 
record  shows.  One  way  of  supplying  this  deficiency  is  to 
record  at  the  beginning  of  the  "treatment  record"  the  general 
plan  that  is  to  be  followed  and  to  indicate  in  the  periodical 
summaries  of  results  the  modifications  of  the  plan  later  adopted. 
Sometimes  a  social  record  will  go  to  the  opposite  extreme  and 
consist  largely  of  the  worker's  own  plans  and  opinions  to  the 
exclusion  of  information  concerning  the  patient.  It  is  easy  to 
slip  into  the  habit  of  recording  intentions  and  impressions 
rather  than  to  make  the  effort  to  secure  facts. 

In  order  to  make  a  clear  distinction  between  the  current  his- 
tory of  the  patient  under  care  and  the  social  worker's  plan  and 
methods  in  treatment,  an  effort  was  made  for  a  time  to  keep 
a  "treatment  sheet"  separate  from  the  main  case  record.  (For 
examples,  see  cases  14,  17,  and  36.)     This  attempt  had  to  be 


538  THE    KINGDOM    OF    EVILS 

given  up  under  pressure  of  work  after  a  short  trial ;  but  the 
device  seems  to  us  to  offer  promise  of  better  study  of  method 
in  social  case  work.  At  the  same  time  it  has  a  tendency  to 
make  the  treatment  more  definite  and  effective,  and  to  stimu- 
late ingenuity  and  resourcefulness  in  the  social  worker.  It 
might  be  just  as  well  to  make  the  "treatment"  entries  on  the 
regular  record  instead  of  on  a  separate  "treatment  sheet,"  pro- 
vided the  statements  of  aims  and  methods  were  arranged  in 
such  a  way  that  they  would  stand  out  clearly. 

TECHNIQUE  OF  SOCIAL  DIAGNOSIS  AND  TREATMENT 

Concerning  the  technique  of  social  diagnosis  and  treatment 
we  do  not  claim  any  approach  to  complete  discussion,  even  of 
the  facts  which  we  note  in  this  book.  As  a  preface  to  such 
remarks  as  we  make  below  upon  social  technique  and  diag- 
nosis, we  wish  to  speak  of  what  has  been  called  "family  case 
work"  and  to  make  a  general  remark  about  it.  The  unit  of 
interest  in  social  case  work,  like  the  unit  of  interest  in  social 
reform  and  even  in  theoretical  sociology,  has  often  been  the 
family  group.  "As  society  is  now  organized,"  says  Richmond 
in  Social  Diagnosis,  "we  can  neither  doctor  people  nor  edu- 
cate them,  nor  launch  them  into  industry,  nor  rescue  them 
from  dependence  in  a  thoroughly  social  way  without  taking 
their  family  into  account.  Even  if  our  measures  were  for  the 
welfare  of  the  individual  solely  we  should  find  that  the  good 
results  of  individual  treatment  crumble  away  often  because 
the  case  worker  has  been  ignorant  of  his  client's  family  his- 
tory." (Richmond  used  the  term  client  instead  of  the  term 
patient,  which  at  least  in  medical  social  work  seems  to  us 
preferable.)  Briefly  put  individualization  in  social  treatment 
unconditionally  requires  consideration  of  the  family  group. 
Richmond  quotes  the  Swiss  neurologist  Dubois  and  the  Ameri- 
can neurologists  Healy  and  Putnam  in  support  of  these  con- 
tentions with  which  we  must  all  perforce  agree.  The  follow- 
ing items  in  the  family  group  relations  are  discussed  by  Rich- 
mond. The  main  drift  of  the  family  life,  what  is  it  on  the 
whole?  The  important  distinction  between  the  united  family 
and  the  unstable  family  (especially  emphasized  by  Mrs. 
Bosanquet  in  her  book  The  Family).  The  necessity  of  "see- 
ing the  man"  as  well  as  the  mother  of  the  family  and  of  seeing 


THE    KINGDOM    OF   EVILS  539 

him  at  home;  the  question  of  the  unmarried  father;  the  ques- 
tion of  the  young  couple  requiring  reUef ;  problems  of  de- 
sertion and  inebriety;  the  wife  and  mother;  the  home  situa- 
tion; the  family  housing;  children  (here  we  find  the  blood 
relationship  and  all  those  undercurrents  of  antagonism  which 
it  implies)  ;  the  other  members  of  the  family  group  including 
undesirable  relatives.  Volumes  should  and  must  be  written 
upon  these  questions  of  the  family  group.  Of  particular  value 
in  a  study  of  family  cohesions  (the  united  and  the  unstable 
family  as  distinguished  by  Le  Play)  will  be  the  psychiatric 
point  of  view.  Families  are  said  to  "arrange  themselves  along 
a  scale  with  the  degenerate  family  at  one  end  and  the  best  type 
of  united  family  at  the  other."  But  what  is  the  degenerate 
family  in  many  or  most  instances  except  a  family  with  psycho- 
pathic trends  in  one  or  more  members?  Then  there  are  in- 
stances like  that  of  Henry  Loyal  (case  4)  of  Book  I  in  which, 
except  at  times,  there  was  extraordinary  close  cohesion  of  a 
degenerate  family.  Even  in  this  instance  the  family  "solidarity" 
proved  as  social  workers  have  always  insisted  to  be  the  greatest 
asset.  Another  good  psychiatric  point  is  the  systematic  point 
of  seeing  husband  and  wife  separately  so  that  each  may  get  an 
individual  opportunity  to  present  the  personal  view.  .Where 
character  deviation  enters,  this  point  comes  out  in  strong  relief. 
With  respect  to  the  unmarried  father  as  well  as  the  unmarried 
mother,  an  enormous  insistence  has  to  be  made  according  to  our 
view  upon  the  question  of  greater  or  lesser  feeble-mindedness 
in  the  erring  parent.  If  a  wife  and  one  or  two  babies  of  a 
young  able-bodied  man  in  ordinary  times  need  any  service  that 
involves  social  work,  this  is  a  situation  that  demands  the 
closest  scrutiny  and  to  our  mind  the  closest  psychiatric 
scrutiny.  Neglectfulness,  slackness  of  such  degree  as  to  in- 
volve the  necessity  of  dole-giving,  certainly  need  a  psychia- 
trist's attention.  "Laziness"  is  another  phenomenon  which 
not  seldom  turns  out  to  be  in  some  way  psychological. 

Inebriates  would  nowadays  one  and  all  be  subject  to  psy- 
chiatric scrutiny.  There  is  one  set  of  statements  that  can 
safely  be  made  about  all  inebriates.  Richmond  quotes  Neff 
favorably  to  the  effect  that  "the  treatment  of  the  inebriate  can 
best  be  expressed  in  the  word  individualization."  The  like  can 
be  said  of  the  family  deserters,  male  or  female.  Perhaps  the 
relation  of  psychiatry  is  not  too  evident  in  questions  of  home- 


540  THE    KINGDOM    OF   EVILS 

making  and  family  housing  and  many  programs  of  social  re- 
form have  in  the  past  endeavored  to  center  upon  conditions  of 
housing  and  home-making,  which  w^ould  in  part  at  least  derive 
not  so  much  from  economical  disability  as  from  ignorance, 
bad  habits,  or  even  mental  defect.  It  is  extraordinary  what 
different  reports  will  be  rendered  concerning  some  family  sit- 
uations by  workers  who  have  the  economic  view  uppermost 
and  by  psychiatric  workers.  As  for  children,  here  the  work 
of  Healy,  as  Richmond  rightly  claims,  is  far  beyond  his  chosen 
scope  of  mere  delinquency  and  points  the  path  of  psychiatric 
social  work  far  beyond  the  confines  of  potential  crime.  The 
psychiatric  worker  tends  to  look  at  social  situations  rather  than 
at  family  groups.  The  psychiatric  social  worker  finds  social 
situations  dominated  by  psychopaths,  by  one  or  more  persons 
whose  mental  disease  or  disorder  may  be  extremely  mild  and 
entirely  invisible  to  members  of  the  social  group  in  question. 
Sometimes  the  remote  members  of  the  family  group  or  the 
boarders  and  lodgers,  and  even  the  neighbors,  may  have  a 
more  penetrating  view  of  what  is  really  going  on. 

We  are  more  and  more  tending  to  insist  that  each  social 
situation,  looked  into  by  the  psychiatric  social  worker,  shall  be 
analyzed  in  the  end  according  to  the  number  of  persons  in- 
volved. This  number  of  involved  persons  may  be  small  or 
large.  But  we  almost  always  find  that  the  number  of  distinct 
and  separate  points  of  view  in  each  social  situation  is  com- 
paratively small.  In  a  quarrel  between  a  husband  and  wife 
there  may  be  two  points  of  view  and  the  social  worker  may 
add  the  third  point  of  view.  Whereas  the  husband  and  wife 
are  agreeing  to  disagree  within  four  walls,  the  social  worker 
may  upon  analysis  advise  another  policy,  that  of  separating 
husband  and  wife  for  a  longer  or  shorter  period.  Of  course 
the  worker  cannot  execute  any  such  policy  without  the  consent 
and  approval  of  all  legal,  ecclesiastical,  and  medical  authorities 
engaged ;  the  supposition  in  the  textbook  is  that  the  decision 
of  the  social  \\orker  is  supported  by  these  authorities.  Or 
again  the  husband  and  wife  may  have  separated  and  entertain 
antagonistic  views  of  what  the  family  ought  to  do,  whereas 
the  social  worker  may  leap  into  the  situation  with  the  idea  of 
reunion.  The  point  we  here  make  is  that  after  all  the  persons 
in  the  social  situation  have  been  listed  (somewhat  after  the 
manner  of  the  dramatis  personae  in  plays)  the  really  distinct 


THE    KINGDOM    OF    EVILS  541 

and  separate  points  of  view  in  the  social  situation  are  to  be 
analyzed  and  listed  (just  as  one  might  distinguish  the  prin- 
cipals and  accessories  in  a  dramatic  cast).  We  have  not  con- 
sciously adopted  this  method  to  any  extent  in  the  analysis  of 
the  material  of  this  volume,  although  in  effect  we  have  often 
got  practical  results, — consider,  for  example,  Henry  Loyal 
(case  4)  or  Alice  Nardini  (case  31). 

But  how  shall  we  distinguish  the  principals  and  the  acces- 
sories and  the  less  important  units  in  the  social  situation  ?  The 
psychiatric  social  worker  learns  that  the  family  is  not  the  unit 
of  interest  for  psychiatric  social  work  but  finds  that  the  unit 
of  interest  is  the  individual  in  his  group.  There  will  be  found 
one,  two,  three,  four,  or  perhaps  sometimes  five,  but  rarely 
more  than  five,  human  units  of  interest  in  social  situations. 
The  children  may  split  as  to  what  they  want  done,  some  going 
with  the  father  and  some  going  with  the  mother.  Relatives 
may  take  a  third  point  of  view  separate  from  that  of  the  father 
and  mother.  Sometimes  the  social  worker  may  enter  with 
still  a  fourth  point  of  view  and  so  on.  But  many  of  the  per- 
sons listed  as  engaged  in  the  social  situation  turn  out  to  be  of 
subordinate  importance  in  that  situation.  They  add  themselves 
in  to  enforce  a  little  more  strongly  some  particular  policy  but 
they  are  accessories  agreeing  with  the  policies  of  some  prin- 
cipal. How  shall  these  principals  be  defined?  They  are,  we 
think,  non-interchangeable  elements  in  the  social  situation. 
They  are  not  merely  associates  like  the  members  of  a  club 
but  they  are  consociates  like  the  officers  of  a  club  that  have 
separate  functions  not  interchangeable  with  one  another.  How 
many  separate,  non-compatible,  non-interchangeable  points  of 
view  are  logically  to  be  found  in  a  social  situation?  This  is 
the  real  question  which  the  social  case  worker  must  strive  to 
answer.  The  family  is  a  consociate  group  of  persons  (as 
father,  mother,  children)  having  separate  and  non-interchange- 
able functions.  Their  intimacy  of  relation,  or,  as  we  may  say, 
their  consociate  relationship  may  fall  apart,  particularly  under 
the  influence  of  something  psychopathic  in  some  member  of 
the  group.  They  become  mere  associate  members  of  the  group 
— that  is  to  say,  they  are  no  longer  intimately  united  with  one 
another  or  even  possibly  quite  antagonistic.  Indeed,  their  an- 
tagonisms may  be  so  intimate  that  they  become  almost  friendly 
enemies,  suggesting  mutual  antagonism,  like  two  universities 


542  THE    KINGDOM    OF    EVILS 

such  as  Harvard  and  Yale.  These  members  of  the  group  whose 
views  simply  add  themselves  into  the  views  of  some  principals 
in  the  situation  are  merely  associates  in  the  situation.  Their 
views  are  interchangeable  with  one  another.  They  numerically 
strengthen  a  point  of  view — they  do  not  determine  it. 

It  is  upon  these  lines  that  we  predict  the  careful  social 
analyses  of  the  future  will  run.  Upon  these  lines  we  shall 
study  more  effectively  the  relations  of  man  to  man,  man  to 
woman,  and  woman  to  woman,  whether  these  relations  are 
dual,  triple,  quadruple,  or  still  more  complex.  Throughout  all 
this  study  the  psychiatric  social  worker  will  be  apt  to  see  with 
great  clearness  the  predominate  importance  of  the  psycho- 
path. But  the  psychiatric  social  worker  will  study  each  mem- 
ber of  the  social  situation  individually,  and  each  from  his  own 
personal  point  of  view,  so  that  there  will  be  no  psychiatric 
prejudice  in  the  long  run.  We  conceive  that  this  kind  of 
analysis  has  a  range  much  greater  than  yet  afforded  by  avail- 
able analyses  of  the  family  group.  But  we  also  know  that  it 
would  take  a  long  time  to  reach  the  confines  of  the  vista. 

Discrimination  between  the  summation  of  evils  and  the 
multiplication  of  evils  has  been  referred  to  (case  8)  as  hav- 
ing a  bearing  upon  social  treatment.  In  one  case  the  elements 
of  disorder  may  be  loosely  combined,  heaped,  while  in  another 
case  they  are  tightly  combined,  coiled.  It  is  important  to  know 
whether  we  are  dealing  with  siinnnands  or  factors.  Evils 
multiply  into  one  another.  The  effect  of  hypersexuality  and 
lack  of  information  about  sex  lead  to  more  difficulty  com- 
bined than  the  sum  of  the  two  evils  alone.  (See  also 
Book  IV.)  The  case  of  Rose  Talbot,  intelligent  sex  delin- 
quent (case  8),  gives  an  elaborate  example  of  tightly  coiled 
troubles.  A  contrast  of  our  first  case,  Agnes  Jackson,  with 
this  case  brings  out  clearly  the  sum  of  troubles  versus  the 
product.  The  Jackson  case  is  a  simple  additive  case, 
M-|-E-|-V+L+P,  while  Rose  Talbot  is  a  complex  multiplica- 
tive case,  MXEXVXLXP.  In  a  multiplicative, 
interpretative  case,  if  you  remove  poverty  you  change  the  whole 
situation;  but  in  the  simpler  additive  case  you  may  send  the 
patient  for  various  sorts  of  help  to  various  sources,  dealing 
with  his  difficulties  one  by  one.  The  case  of  Elliot  Calderwood, 
misrepresented  "little  fiend"  who  proved  quite  amenable  (case 
22),  as  an  example  of  educational,  legal,  and  economic  diffi- 


THE    KINGDOM    OF   EVILS  543 

cultles,  is  a  case  in  which  the  factors  of  difficulty  were  not  in- 
terwoven in  any  practical  sense  and  could  be  disposed  of  in 
turn, — the  misunderstanding  with  the  court  set  right  (L),  a 
home  provided  (P),  education  started  (E). 

Will  the  difficulty  of  social  treatment  vary  with  the  tightness 
of  the  coil,  or  on  the  other  hand  will  the  whole  coil  unravel 
quickly  when  the  secret  is  found?  There  may  be  cases  for 
quick  treatment,  where  a  single  line  of  action  will  solve  the 
problem.  Cases  that  are  sums  of  social  trouble  mean  increase 
of  steps  to  be  taken  in  treatment, — they  are  logically  simple 
but  time-consuming.  We  cannot  hope  to  do  more  in  this  book 
than  suggest  the  idea  of  the  social  sum  versus  the  social 
product  as  a  method  of  approach  in  social  treatment. 

Psychiatric  social  work  employs  the  technique  of  general 
social  work  in  so  far  as  systematic  methods  have  been  de- 
veloped in  social  case  work.  There  exists  a  certain  amount  of 
technique  of  social  examination  (usually  called  "the  investiga- 
tion") that  is  now  generally  agreed  upon  and  made  available 
in  the  literature  of  social  work,  and  a  smaller  amount  of  tech- 
nique of  social  treatment,  which  is  fairly  definite,  although 
still  somewhat  tentative.  Scientific  methods  of  examination 
will  naturally  precede  scientific  methods  of  treatment,  for  al- 
though in  the  development  of  its  practice  social  work  first 
learned  to  treat  and  later  learned  to  examine  (or  "investi- 
gate"), in  the  development  of  scientific  method  examination 
must  necessarily  come  before  treatment.  So  that  the  newly 
created  psychiatric  social  worker  finds  already  at  hand  a  con- 
siderable body  of  systematized  experience  in  examination  and 
a  small  amount  in  treatment.  Obviously  it  is  the  part  of  wis- 
dom to  acquire  this  technique,  which  is  the  accumulated  experi- 
ence of  twenty-five  years  or  so  of  tentative  effort  toward  scien- 
tific method.  The  new  psychiatric  social  worker  impatient 
with  the  disregard  of  mental  science  in  the  general  technique 
may  have  an  impulse  to  discount  the  experience  of  social 
workers  in  the  past  and  begin  all  over  again.  Sometimes  under 
the  influence  of  physicians  whose  acquaintance  with  social  work 
in  the  past  has  been  slight,  and  perhaps  on  that  account  unsat- 
isfactory, the  psychiatric  social  worker  is  inclined  to  discard 
the  incomplete  technique  of  social  work  altogether,  and  to  feel 
a  naive  responsibility  to  create  a  new  profession.  But  the  ex- 
isting technique  is  not  so  much  incorrect  as  it  is  incomplete. 


544  Tf"HE   KINGDOM    OF  EVILS 

The  ambition  of  psychiatric  social  work  should  be  to  modify 
and  add  to  the  general  technique  of  social  work  new  methods 
developed  by  special  experience  with  psychiatric  cases. 

Some  of  the  more  conspicuous  points  at  which  psychiatric 
social  work  may  be  expected  to  influence  the  technique  of  case 
work  are:  (a)  individualization  in  both  examination  and 
treatment;  (b)  objective  accurate  observation;  and  (c)  train- 
ing of  character  through  use  of  the  emotions.  The  subject  of 
individualization  has  been  discussed  elsewhere.  (See  cases  48 
and  87,  also  pages  378  and  379.) 

Focusing  upon  the  individual  soon  leads  to  the  recognition 
of  the  fact  that  human  beings  are  infinitely  varied  and  cannot 
be  rated  for  practical  purposes  at  certain  levels  of  merit. 
Within  the  same  personality  are  to  be  found  faults  and  virtues, 
abilities  and  disabilities.  This  point  of  view  often  gains  re- 
spect for  even  the  most  unsuccessful  individual.  In  cases 
where  failure  is  due  to  natural  causes  too  strong  for  the  in- 
dividual's control,  the  knowledge  of  this  fact  will  eliminate 
the  attitude  of  blame  that  we  instinctively  feel  for  misconduct. 
The  question  of  praise  and  blame  is  important  for  social 
workers.  Undoubtedly  much  harm  is  done  by  the  discourage- 
ment and  loss  of  energy  that  blame  produces;  and  praise  is 
obviously  an  effective  therapeutic  agent.  One  of  the  primary 
aims  of  the  social  worker  is  to  deepen  the  sense  of  moral  re- 
sponsibility ;  a  process  which  is  apt  to  involve  frequent  expres- 
sion of  disapproval.  But  it  is  doubtful  whether  reproof  and 
blame  promote  this  object.  The  truth  of  the  matter  probably 
is  that  reproof  or  blame  as  ordinarily  administered  is  com- 
pounded of  our  knowledge  of  the  error  and  our  impatience 
with  it.  It  is  perhaps  the  tinge  of  personal  impatience  that 
gives  blame  its  unpleasant  quality.  Many  unfortunate  psycho- 
paths who  have  been  censured  and  despised  by  acquaintances, 
and  often  by  social  workers,  when  they  meet  the  psychiatric 
point  of  view,  feel  a  sense  of  relief  and  renewed  self-respect 
and  are  stimulated  to  fresh  effort.     (See  cases  2,  4,  6,  12,  13, 

52' 98-) 

Another  product  of  the  psychiatric  point  of  view  is  the  habit 
of  objective  observation — the  study  of  an  individual  as  he 
really  is,  not  as  we  feel  that  we  should  be  in  his  place,  or  as 
he  himself  tells  us  that  he  is.  In  social  case  work  we  need  to 
know  accurately  the  nature  of  our  patient  or  client.     We  do 


THE    KINGDOM    OF    EVILS  545 

him  an  injustice  if  we  form  a  conception  of  him  in  terms  of 
our  own  experience.  His  own  account,  though  honestly 
meant,  may  not  be  accurate.  Through  observation  of  his  be- 
havior and  reports  of  other  observers  upon  his  conduct,  the 
best  account  of  his  character  is  to  be  obtained.  When  we  come 
to  the  point  of  trying  to  understand  him,  we  must  necessarily 
think  in  terms  of  our  own  experience,  but  the  objective  study 
should  precede  the  interpretation.  We  first  find  out  what  an 
individual  is  like,  and  then  think  how  we  should  feel  and  act 
if  we  were  like  that.  This  process  of  objective  study,  preced- 
ing subjective  understanding,  simplifies  many  problems  in 
social  work  and  promotes  sympathy.  Personalities  quite  un- 
like our  own  when  studied  objectively  become  comprehensible. 
Training  through  use  of  the  emotions  rather  than  through 
appeal  to  reason  is  a  familiar  technique  of  everyday  life  in 
dealing  with  children  and  in  getting  our  own  way.  Everyone 
is  familiar  with  the  practice  of  asking  a  favor  when  the  pros- 
pective donor  is  in  a  good  humor,  and  upon  the  strength  of  the 
resulting  good  feeling  after  a  suitable  interval  asking  another 
favor,  thereby  helping  to  develop  habits  of  generosity  in  the 
donor.  Such  technique  seems  to  be  the  most  hopeful  method 
of  training  individuals  in  whom  misconduct  is  the  result  of 
emotional  instability.  In  discussing  this  point  we  cannot  do 
better  than  to  quote  somewhat  at  length  from  A  Psychiatric 
Contribution  to  the  Stu/^y  of  Delinquency,  by  Dr.  Herman 
M.  Adler  (see  also  page  487),  who  as  chief  of  stafif  at  the  Psy- 
chopathic Hospital  guided  the  first  efforts  of  the  social  service 
in  cases  of  delinquency: — 

"It  would  seem  that  by  careful  training  based  upon  an  analy- 
sis of  each  individual — especially  from  the  behaviorist's  point 
of  view,  considering  the  past  life  and  career  rather  than  self- 
explanatory,  subjective  statements — it  would  be  possible  to 
influence  the  future  conduct  of  these  individuals  {i.e.,  the 
emotionally  unstable).  While  their  fundamental  equipment 
cannot  be  changed,  these  people  suffer  more  from  the  effects  of 
their  conduct  than  from  their  subjective  attitude  towards  them- 
selves or  their  environment. 

"Thus,  as  Kraepelin  points  out,  alcohol  is  an  important  fac- 
tor in  producing  the  final  downfall.  Extravagance,  profligacy, 
sex  excesses,  bad  companionship,  and  so  forth,  are  the  factors 
which  combine  to  cause  the  social  difficulties.  The  suggesti- 
bility of  these  individuals,  their  intelligence  and  insight,  which 


546  THE    KINGDOM    OF    EVILS 

is  usually  adequate  for  their  needs,  can  be  made  use  of  in 
acquiring  and  strengthening  the  habits  which  the  individual 
would  never  be  able  to  gain  if  left  to  himself. 

"What  is  desired,  therefore,  is  a  system  of  mental  and  emo- 
tional exercises  for  the  purpose  of  habit  formation.  This 
might  be  designated  as  orthopsy chics.  This  term  is  further 
applicable  in  that  a  good  many  of  those  cases  are  instances  not 
of  disease  in  the  sense  of  an  acquired,  deteriorating  process,  but 
rather  comparable  to  physical  deformities.  For  the  present, 
our  experience  in  orthopsychics  is  limited.  We  have  had  a 
few  cases  in  which,  after  a  preliminary  survey  at  the  Psycho- 
pathic Hospital,  a  course  of  training  has  been  applied,  which 
has  consisted  above  all  in  arousing  the  interests  and  appealing 
to  the  pleasure-loving  side  of  the  individual.  It  is  a  well- 
known  fact,  for  instance,  in  dealing  with  wayward  young 
people  that  even  under  the  most  advantageous  circumstances 
and  even  with  the  most  favorable  and  friendly  environment, 
the  individuals  do  not  do  well.  This  appears  to  be  due  to  the 
fact  that  the  emotional  impulses  are  of  short  duration  and  leave 
no  strong  impressions  behind  them.  Therefore,  when  the 
novelty  of  a  situation  has  worn  ofif,  there  is  nothing  to  hold  the 
interests  of  the  delinquent  and  tide  over  the  tedious  days  of 
monotonous  routine. 

"We  have  proposed  in  a  number  of  cases  (and  have  carried 
it  out  to  some  extent  in  a  few)  to  arrange  to  change  the  en- 
vironment of  each  individual  before  the  novelty  has  quite  worn 
off.  The  length  of  time  in  which  an  individual  stays  in  each 
home  varies  in  each  instance,  and  must  be  determined  carefully 
each  time.  We  are  all  so  prejudiced  by  our  early  ethical 
training  that  it  is  difficult  to  be  ])erfectly  objective  in  dealing 
with  these  people.  It  is  hard  to  eliminate  pedagogic  and  purely 
academic  demands  for  that  which  we  consider  right.  None 
the  less,  this  must  be  done,  and  in  every  instance,  in  every 
disagreement,  at  every  change  in  the  routine  of  the  individual, 
emphasis  must  be  laid  on  the  fact  that  it  is  done  from  a  medical: 
point  of  view,  that  is,  from  a  point  of  view  of  theirapy  and! 
help,  with  kindly  feelings  toward  the  patient,  and'  never-  as  a. 
corrective  or  as  a  punishment,  and  al)Ove  all.  never-  vind'ictiVel'y., 

"Education  and  training,  therefore,  rather  than  punishment 
are  the  methods  that  hold  out  a  chance  of  success.  These  indi- 
viduals are  not  able  to  team  by  experience.  They  receive  the 
equivalents  of  punishment  in  their  daily  life,  which  are  suffi- 
cient to  influence  the  formation  of  adequate  resistance  in  a 
normal  individual.  In  these  individuals,  while  they  often  recog- 
nize the  full  significance  of  those  circumstances  in  which  their 


THE    KINGDOM    OF    EVILS  547 

delinquencies  placed  them,  their  experi-inces  have  no  corrective 
influence. 

"To  punish  such  an  individual,  therefore,  is  to  increase  his 
defeat  rather  than  to  strengthen  his  defenses.  It  is  like  admin- 
istering alcohol  to  the  patient  suffering  from  delirium  tremens. 
It  is  like  injecting  diphtheria  toxin  into  the  circulation  of  a 
patient  suffering  from  diphtheria.  We  may  draw  a  final  anal- 
ogy from  immunology  in  applying  this  therapy : 

"The  first  duty  is  protection  against  the  immediate  effects  of 
the  acute  attack.  In  our  cases,  this  means  freeing  them  from 
their  immediate  difficulties,  supplying  them  with  food  and  lodg- 
ing, helping  them  to  recover  from  alcohol  and  drug  intoxica- 
tion, relieving  their  physical  symptoms,  curing  them  of  venereal 
disease,  and  building  up  their  physical  health. 

"In  the  second  place,  immunization :  This  is  often  in  the 
nature  of  after  care,  and  cannot  be  achieved  at  once,  but  can 
be  accomplished  by  a  building  up  of  the  defense  habits,  by 
training,  and  not  by  overwhelming  an  already  breaking  organ- 
ism with  the  hostile  conditions,  but  by  gradually  strengthening 
their  habits  so  that  they  will  meet  the  particular  unfavorable 
conditions  without  fear  of  breakdown.  In  the  group  of  emo- 
tionally unstable,  this  offers  great  hope." 

The  relation  of  social  worker  to  patient  (or  client)  seems 
to  be  causing  the  development  of  a  new  professional  attitude. 
The  ideal  attitude  of  the  established  professions,  such  as  medi- 
cine, education,  theolog}',  is  one  of  authority  and  impersonal 
friendliness.  The  effective  attitude  for  the  professional  social 
worker  is  essentially  the  same,  but  the  proportions  of  authority 
and  friendliness  are  reversed,  and  the  friendliness  is  less  im- 
personal. The  social  worker  (except  the  probation  officer) 
carries  no  such  authority  as  the  institutions  of  hospital,  school, 
and  church  bestow,  but  must  rely  for  prestige  upon  her  ability 
to  help.  The  friendliness  of  her  relation  to  the  patient,  in 
sticcessfut  treatment,  i"s  of  a  high  degiree;-  for  almost  imme-- 
diiately  she  secures  an  exceptional  intimacy  with  the  patient's, 
whol'e  interior  and  exterior  situation.  The  patient  responds  to. 
this  sudden  intimacy  by  regarding  her  as  a  near  friend.  To 
influence  him  throughout  the  intricacies  of  social  adjustment 
she  must  preserve  this  regard.  She  must  identify  herself  with 
him,  directing  him  from  his  own  point  of  view,  giving  him 
the  counsel  of  "a  friend"  not  merely  the  advice  of  "an  au- 
thority."    On  the  other  hand  she  must  preserve  enough  of 


548  THE    KINGDOM    OF    EVILS 

the  element  of  authority  to  be  a  decided  and  respected  influence. 
This  continuous  intimate  relationship  is  apt  to  make  the  social 
worker  very  sympathetic ;  but  even  in  the  most  appealing  cases 
she  must  combine  with  her  sympathy  an  objective  impersonal 
attitude  that  will  leave  her  judgment  free.  When  it  is  said 
in  justification  of  a  social  worker  "she  puts  her  heart  into  her 
work,"  it  must  not  be  forgotten  that  the  patients  have  a  claim 
upon  her  head  as  well.  The  social  worker  must  find  a  way 
to  be  at  the  same  time  a  personal  friend  and  an  impersonal 
adviser. 

The  fact  that  the  social  worker  stands  to  the  patient  in  the 
light  of  a  friend  might  seem  to  argue  the  importance  of  hav- 
ing but  one  worker  deal  with  a  case  throughout  the  period  of 
social  treatment.  But  this  In  our  experience  is  not  so  impor- 
tant as  it  might  seem.  A  change  of  workers  can  be  made  with- 
out loss  and  may  even  be  an  advantage.  In  any  case  under 
long-time  treatment,  with  the  changing  stafif  of  a  hospital,  it 
is  unavoidable  that  there  should  be  several  different  workers 
in  succession.  Some  of  our  most  successful  cases  have  had 
as  many  as  six  or  seven  social  workers,  and  three  or  four 
workers  not  infrequently  deal  in  turn  with  one  case  (see  cases 
8,  32,  94).  The  success  of  the  transfer  of  a  case  to  another 
person  depends  of  course  upon  the  skill  of  the  workers  con- 
cerned and  upon  their  consideration  for  the  feelings  of  the 
patient.  In  some  cases  the  patient  likes  his  new  social  worker 
better,  and  in  most  cases  he  feels  it  is  some  advantage  to  have 
acquired  a  new  friend.  There  may  be  of  course  some  loss  in 
a  case  where  tlie  patient  has  gradually  come  to  confide  in  the 
first  worker ;  but  such  loss  is  apt  to  be  overestimated.  The 
bringing  in  of  new  ideas  and  influences  through  a  new  worker 
may  be  a  positive  advantage  to  the  treatment. 

The  patient  will  feel  decided  opposition  to  the  transfer  if 
he  has  formed  an  excessive  attachment  to  the  social  worker, 
but  this  relationship  is  not  to  be  encouraged  in  any  case.  An- 
other reason  for  objection  from  the  patient  may  be  that  he 
fears  opposition  from  the  new  worker  in  something  which  he 
has  been  allowed  to  persist  in  doing.  On  the  whole  we  believe 
the  best  results  come  from  teaching  the  patient  to  look  upon 
the  social  agency  or  the  hospital  as  the  source  of  help  and  direc- 
tion, medical  and  social,  and  inspiring  him  by  uniformly  con- 
siderate treatment  to  feel  confidence  in  every  member  of  the 


THE    KINGDOM    OF    EVILS  549 

Staff  who  deals  with  him.  This  might  appear  as  a  theoretical 
principle  too  ideal  for  application,  were  it  not  that  it  is  a  con- 
clusion derived  from  actual  experience.  We  have  found  the 
point  of  view  to  be  of  more  importance  than  the  personality 
of  the  worker  (see  also  case  8). 

MEDICAL  TREATMENT  IN   SOCIAL  CASE  WORK 

We  do  not  deal  systematically  with  medical  treatment  in 
this  volume.  Hamilton  Green  (case  i8)  was  an  "eye"  case — 
a  man  with  severe  astigmatism.  No  doubt  the  treatment  of 
the  astigmatism  is  indispensable  in  the  handling  of  Hamilton 
Green.  Yet  it  would  be  improper  to  think  of  Green  as  merely 
an  eye  case  or  of  the  treatment  of  his  eyes  as  the  essential 
thing  in  his  case.  Good  but  subordinate  effects  were  gained 
by  baths  for  Agnes  Jackson  (case  i).  In  fact,  the  excellence 
of  hydriatric  treatment  in  cases  of  dementia  praecox  has  been 
pointed  out  by  our  colleague,  H.  M.  Adler,  in  his  analysis  of 
the  effects  of  baths  in  different  forms  of  excitement  (contrary 
to  expectation,  Adler  found  that  better  effects  of  an  important 
nature  were  secured  in  cases  of  dementia  praecox  than  in  cases 
of  manic-depressive  psychosis).  It  would  be  natural  to  draw 
hydrotherapy  into  the  foreground  in  this  or  in  other  cases 
v/ith  which  we  are  familiar.  The  baths  serve  to  draw  patients 
to  hospitals,  and  an  unfailing  stimulus  to  the  size  of  the  out- 
patient clinic  is  the  establishment  of  a  good  hydrotherapy  sys- 
tem so  associated  with  the  clinic  that  proper  hydriatric  pre- 
scriptions can  be  made  for  systematic  treatment.  It  does  not 
do  to  scoff  against  these  baths  as  some  observers  are  apt  to 
scoff.  Possibly  they  are  not  essential  to  the  treatment  of  any 
form  of  mental  disease  whatever  (always  excepting  forms  of 
excitement)  ;  possibly  they  are  not  even  indispensable  aids  in 
treatment  in  many  cases;  but  though  they  may  be  neither 
essential  nor  indispensable  in  treatment,  baths  remain  impor- 
tant aids  to  any  clinic.  Moreover,  it  must  be  conceded  that 
the  true  effects  of  hydrotherapy  have  never  been  scientifically 
measured  by  the  metabolic  chemists  or  otherwise. 

Similarly  with  dental  treatment  which  comes  especially 
into  question  in  the  case  of  Margaret  Dolan  (case  38)  whose 
dental  defects  and  indigestion  complicated  a  mental  situation 
which  was  itself  the  result  of  a  well-founded  wrong.     Despite 


550  THE    KINGDOM    OF    EVILS 

all  Margaret  Dolan's  financial  trouble  and  the  death  of  her  sis- 
ter, she  recovered  with  social  aid.  Another  dental  case  was  that 
of  Nathan  Rosenthal  (case  49).  The  dental  complication  was 
subordinated  here  also,  but  this  always  subordinate  influence 
was  still  important.  Social  workers  so  often  ask  what  the 
effect  of  dental  treatment  is  upon  mental  diseases;  owing  to 
the  fact  that  extraordinary  claims  have  been  made  on  behalf 
of  dental  work  (especially  extraction)  in  cases  of  mental  dis- 
ease. The  public  prints  have  in  recent  years  been  full  of  such 
claims.  The  rational  answer  to  this  question  is  that  a  few 
cases  are  marvelously  benefited  by  proper  dental  treatment. 
These  improvable  cases  are  no  doubt  those  in  which  pyorrhea 
or  other  infection  about  the  teeth  is  responsible  for  mental 
symptoms  through  a  process  of  septicemia  (with  bacterial  in- 
vasion of  the  blood)  or  toxemia  in  which  bacterial  poisons  find 
their  way  into  the  blood.  Michael  Piso  (case  62)  suffered 
extensively  from  pyorrhea  but  the  dental  treatment  thereof  was 
only  a  part  of  the  total  treatment  of  Piso  which  served  in  the 
end  to  raise  his  wages  and  procured  relatively  complete  family 
adjustment  with  abolition  of  jealousy. 

Occupational  therapy  is  a  means  of  treatment  of  the  in- 
sane in  institutions  and  of  psychopaths  outside  of  institutions. 
In  war  time  groups  of  occupational  therapeutists  were  trained 
to  get  ready  for  contingencies  of  disease  amongst  our  Ameri- 
can soldiers;  and  the  work  of  these  occupational  therapeutists 
was  so  good  and  the  outlook  for  their  need  under  civilian  con- 
ditions is  so  well  established  that  the  work  is  likely  to  be  con- 
tinued. An  extensive  literature  has  been  built  up  around  this 
form  of  therapy.  Instances  of  its  employment  are  afforded  by 
Agnes  Jackson  (case  i)  and  Kevork  Ardinian  (case  26), 
though  both  cases  illustrate  relative  failure  rather  than  suc- 
cess in  occupational  therapy.  A  successful  instance  of  its  use 
is  John  Flynn  (case  19). 

Our  group  of  cases  is  decidedly  not  representative  of  the 
values  of  occupational  therapy  and  it  would  be  a  highly 
meritorious  work  for  someone  to  collect  a  series  of  clearly  diag- 
nosticated cases  of  severe  or  mild  mental  disease  and  defect 
for  the  purpose  of  tracing  the  exact  ways  in  which  occupa- 
tional therapy  works  in  the  different  forms  of  psychopathy. 
For  example,  the  reasons  for  the  relative  failure  of  occupa- 
tional therapy  in  Agnes  Jackson  and  its  absolute  failure  in  the 


THE    KINGDOM    OF    EVILS  55 1 

case  of  Kevork  Ardinian  are  different  reasons  and  conse- 
quently do  not  have  a  word  to  say  against  the  general  values 
of  such  therapy.  We  should  not  forget  that  in  the  background 
of  our  minds  the  main  value  of  sending  the  feeble-minded  sub- 
ject to  a  school  for  feeble-minded  is  the  elaborate  occupational 
therapy  which  he  wall  there  secure.  Perhaps  it  is  not  too  much 
to  say  that  the  theory  of  occupational  therapy  will  be  built 
up  from  the  work  of  the  schools  for  the  feeble-minded. 
Workers  in  Massachusetts  and  in  the  country  at  large  are 
familiar  with  the  principles  of  such  therapy  for  the  feeble- 
minded as  developed  by  Dr.  Walter  E.  Fernald  at  the  Massa- 
chusetts School  for  Feeble-minded  in  Waverly.  These  methods 
were  first  proposed  and  in  part  carried  out  by  the  eminent 
early  worker  with  the  feeble-minded,  Seguin.  An  effect 
of  the  new  theory  of  occupational  therapy  for  the  feeble- 
minded as  proposed  by  Seguin,  Fernald,  and  others  is  the 
proposal  by  Madame  Montessori  for  new  methods  of  educa- 
tion of  the  normal.  We  can  forbear  to  insist  that  such  workers 
as  Seguin  and  Fernald  are  working  along  lines  more  in  the 
interest  of  the  normal  than  in  the  interest  of  the  abnormal. 
These  men  and  all  mental  hygienists  are  not  making  the  frontal 
attack  upon  education  which  the  teachers  of  the  normal  are 
making;  but  the  flank  attack  by  these  mental  hygienists  may 
yet  prove  as  successful  as  the  more  obvious  forms  of  frontal 
attack. 

Whilst  we  are  talking  of  occupational  therapy  it  is  impor- 
tant to  remember  also  the  work  for  the  chronic  insane  as  car- 
ried out  in  the  industrial  shops  and  on  the  farms  by  victims 
of  dementia  praecox  and  other  forms  of  mental  deterioration. 
Colonies  for  the  systematic  development  of  the  working  powers 
of  chronic  patients  have  been  established  by  some  state  gov- 
ernments, either  separately  or  in  connection  with  existent  and 
exceptional  units.  From  this  source  also  it  is  to  be  hoped 
that  new  theories  concerning  the  fundamental  principles  of 
work  and  industry  may  accrue.  There  is  hardly  any  better 
way  to  evaluate  the  excellence  of  state  institutions  for  the 
insane  than  to  ask  to  see  the  industrial  shop  work  and  the 
farm  work  of  the  hospital  patients.  The  best  hospitals  have 
efficiency  recording  devices  which  stimulate  their  officers  to 
the  securing  of  higher  quotas  of  active  workers  and  to  increase 
in  the  number  of  hours  of  patient-occupation.     Not  so  much 


552  THE    KINGDOM    OF    EVILS 

can  be  told  from  striking  exhibition  of  arts  and  crafts  by  par- 
ticular  patients  as  from  the  statistical  story  afforded  by  the 
annual  reports  of  institutions.  Occupational  therapy  is  a  most 
important  branch  of  mental  hygiene.  The  theory  of  it  is  in- 
complete.    The  value  of  what  has  been  done  is  not  doubtful. 

EDUCATION   FOR  PSYCHIATRIC   SOCIAL  WORK 

What  difference  will  it  make  to  the  world  whether  we  con- 
sistently unfold  the  social  side  of  the  mental-hygiene  program 
and  develop  a  group  of  trained  psychiatric  social  workers? 
The  functioning  elements  in  the  mental  hygiene  of  the  present 
day  appear  to  be  three  in  number,  all  indispensable  though  of 
different  scope  and  values.  Mental  hygiene  would  of  course 
be  nowhere  without  the  psychiatrist  or  neuropsychiatrist  as 
its  professional  leader.  In  mental  hygiene  conditions  are  the 
same  as  in  the  general  field  of  preventive  medicine  and  public 
health.  After  all,  the  things  to  be  dealt  with  in  the  present 
phase  of  civilization  are  diseases  and  defects,  and  the  fact  that 
mental  diseases  and  defects  come  in  question  does  not  mean 
that  physicians  lose  their  responsibilities  or  can  by  any  means 
hand  them  over  to  psychologists  or  social  workers.  To  be 
sure,  not  all  physicians  have  yet  seen  the  light  of  their  duties 
in  public  health  and  there  may  be  a  few  moribund  psychiatrists 
that  do  not  see  their  responsibilities  in  mental  hygiene.  But 
the  topic  of  mental  hygiene  engrosses  the  interest  of  national 
technical  associations  that  deal  with  mental  and  nervous  dis- 
eases and  plentifully  scatters  the  literature,  quarterly,  monthly, 
and  weekly,  with  propagandist  articles  of  high  level.  Even 
certain  daily  newspapers  carry  mental  hygiene  topics  under 
the  medical  banter. 

But  let  not  the  physician  nor  the  psychiatrist  feel  that 
mental  hygiene  begins  and  ends  with  medicine  or  psy- 
chiatry. The  recent  extensive  review  of  ten  years'  activities 
in  mental  hygiene  by  Dr.  Lewellys  F.  Barker  shows  the  almost 
universal  relativity  of  mental  hygiene,  and  discovers  hardly  a 
field  of  human  activity  to  which  mental  hygiene  is  not  germane. 
But  the  practical  relations  have  so  deepened  and  solidified  in 
certain  places  that  their  intensive  values  almost  outstrip  the 
extensive  relation  which  Barker  so  broadly  expounds.  By 
practical  relations  are  meant  those  above  specified  in  addition 


THE    KINGDOM    OF    EVILS  553 

to  medical  relations ;  namely,  the  relations  with  the  psychologist 
and  the  social  worker. 

For  the  moment  it  is  not  our  duty  to  discuss  the  values  of 
the  psychological  examiner  in  the  field.  Those  values  do 
not  need  to  be  justified.  Recent  analyses  of  concrete  work 
in  our  field  have  shown  that  the  psychologist  can  often  do 
more  in  an  hour's  contact  with  the  patient  than  the  social 
worker  or  even  the  psychiatrist  can  do  in  ten,  twenty,  or  even 
one  hundred  hours  of  contact.  The  trouble  is  that  the  psy- 
chologist runs  out  of  technique  and  method  after  his  hour  is 
up.  He  can  do  nothing  more  in  the  second  hour  of  contact 
with  a  human  being  with  whom  he  is  in  sympathy.  Accord- 
ingly the  work  of  the  psychiatrist  and  of  the  social  worker, 
though  less  intensive  and  powerful  during  the  first  hour  of 
contact  with  the  patient,  lasts  much  longer  and  may  in  the  long 
run  effect  far  more.  Both  from  the  standpoint  of  prescrib- 
ing medical  or  social  adjustments  and  from  the  standpoint  of 
making  these  adjustments  really  work  in  a  compound  environ- 
ment. Let  no  one,  and  especially  let  not  the  psychiatrist  or 
the  social  worker,  look  with  contempt  or  with  uneasy  appre- 
hensiveness  on  the  work  of  the  psychologist.  But  the  psy- 
chologist is  a  scientific  rather  than  a  practical  person.  He 
has  at  his  command  more  the  method  of  a  science  than  the 
technique  of  an  art.  He  differs  in  his  relation  to  our  topic 
from  the  psychiatrist  and  from  the  social  worker,  both  of 
whom  are  primarily  engaged  in  the  practical  arts  of  medicine 
and  social  work.  To  be  sure,  the  difference  between  applied 
science  and  the  technique  of  a  highly  advanced  art  is  so  very 
slight  that  a  pragmatist  might  well  inquire  whether  they  were 
not  identical.  Now  and  then  a  psychologist  will  be  found 
claiming  himself  to  be  a  sort  of  practitioner.  He  claims  to 
become  a  sort  of  social  or  psychic  technician  rather  than  a 
methodologist  at  work  at  the  fundaments  of  things.  But  on 
the  whole  the  psychologist  remains  "-ologist,"  a  man  of  science, 
and  after  he  has  exactly  applied  his  strict  categories  in  a  brief 
time  to  the  problems  of  the  patient  or  to  the  classifications 
of  an  applicant  for  work,  his  province  as  a  psychologist  comes 
to  a  sharp  limit,  beyond  which  hrs  activities  are  little  more 
than  those  of  an  educated  layman. 

We  trust  that  in  all  this  we  shall  not  be  charged  with  be- 
littling psychology  which  as  a  science,  and  as  in  some  sense 


554  THE    KINGDOM    OF   EVILS 

the  deepest  of  sciences,  must  in  the  long  run  prove  as  broad 
a  field  as  that  o£  medicine  or  even  as  the  fields  of  physics 
and  chemistry.  There  is  nothing  that  one  would  like  better 
than  to  contribute  to  psychology  as  a  science.  Nevertheless 
psychology  contributes  method  rather  than  technique,  is  work- 
ing at  the  fundaments  and  generalities  rather  than  the  outcrops 
and  specialties  of  social  work. 

What  then  shall  we  say  about  the  social  worker?  In  the 
first  place  there  may  be  some  lingering  doubts  in  the  minds  of 
physicians,  or  administrators,  of  politicians,  of  various  chari- 
table authorities,  whether  there  is  a  definite  field  of  social 
v/ork,  but  we  take  it  that  the  National  Conference  of  Charities 
and  Correction,  recently  renamed  the  National  Conference  of 
Social  Work,  proves  in  all  its  recent  transactions  that  there  is 
a  field  of  social  work.  It  is  in  point  that  Isaac  Ray,  perhaps 
the  greatest  of  the  early  American  psychiatrists,  was  one  of 
the  founders  of  the  Social  Science  Association.  Nowadays 
we  think  more  of  social  arts  than  social  science  and  it  was 
rather  a  service  to  our  cause  to  have  the  National  Conference 
name  itself  a  Conference  of  Social  Work,  though  the  phrase 
is  at  first  sight  bungling  enough.  The  object  of  these  workers 
in  selecting  that  title  was  not  that  they  felt  themselves  the  only 
workers  in  the  world  but  that  they  did  not  wish  to  be  dubbed 
"scientific"  and,  as  we  in  the  American  scene  so  constantly 
say,  impractical. 

It  is  entirely  clear  that  social  work  is  taken  by  most  of  its 
votaries  and  propagandists  as  an  art  and  not  as  a  science. 
This,  it  seems  to  me,  is  as  it  should  be.  The  social  worker 
has  in  some  ways  identical  aims  and  purposes  with  those  of 
the  psychiatrist.  Both  are  practical  workers  engaged  in  social 
and  medical  arts  which  to  some  extent  fuse  and  overlap  but 
which  in  the  long  run  will  not  interfere  with  each  other  any 
more  than  the  physician  and  the  nurse,  or  the  public-health 
man  and  the  public  health  nurse,  will  interfere  with  one  an- 
other. Two  psychic  bodies  can  occupy  the  same  place  at  the 
same  time  without  breaking  any  important  laws  of  the  world's 
construction.  It  is  perhaps  hard  to  get  both  the  physician  on 
the  one  side  and  the  social  worker  on  the  other  to  acknowledge 
the  indispensability  of  each  in  a  field  where  a  single  authority 
appears  to  be  necessary — the  field,  namely,  of  the  family  dis- 
rupted by  its  central  or  subordinate  psychopathic  figures. 


THE    KINGDOM    OF   EVILS  555 

Let  US  assume  in  this  argument  that  the  physicians  and  the 
social  workers  in  general  agree  upon  their  respective  duties 
with  respect  to  the  same  corpus  vile. 

What  now  about  the  medical  social  workers?  Is  not  med- 
ical social  work  a  very  special  and  limited  field  within  social 
work  in  general  ?  Is  not  social  work,  the  technical  or  applied 
side  of  sociology,  an  economic  rather  than  a  therapeutic  field? 
Will  not  the  bulk  of  the  problem  be  settled  on  an  economic 
line?  What  the  statistical  truth  here  is  remains  obscure.  All 
medical  social  workers  will  agree  that  whatever  the  statistical 
truth  about  mere  economics  as  applied  to  social  difficulty,  there 
is  enough  to  do  in  medical  social  work  to  require  a  large  corps 
of  especially  trained  medical  social  workers.  There  is  now 
in  its  early  years  of  development  an  association  of  medical 
or  hospital  social  workers,  the  American  Association  of  Hos- 
pital Social  Workers,  which  is  to  meet  an  affiliation  with  the 
National  Conference  of  Social  Work.  The  medical  social 
workers  form,  as  it  were,  a  neat  little  trades-union  of  their 
own.  They  do  not  require  laudation  or  special  support  from 
any  source.     Medical  social  work  has  justified  itself. 

What  about  psychiatric  social  work?  Every  medical  social 
worker  should  obviously  receive  a  large  amount  of  social  psy- 
chiatric training  in  his  or  her  school  of  social  work,  and 
a  fortiori  should  receive  more  and  more  if  the  mental  hygien- 
ists  are  right  in  thinking  that  more  than  one  out  of  every  two 
cases  of  social  trouble  is  a  psychiatric  case.  Should  there 
not  be  courses  developed  in  connection  with  every  school  of 
social  work  that  shall  give  a  sufficient  fundamental  training 
to  social  workers  in  psychiatry  to  allow  them  to  effect  proper 
contacts  in  their  practice?  This  is  undeniable  and  we  are 
heartily  in  accord  with  a  program  for  giving  the  psychiatric 
touch  SO'  far  as  that  is  possible  to  every  social  worker.  It  is 
almost  inconceivable  that  social-work  courses  have  not,  for  a 
decade  past,  developed  in  their  curricula  lectures  and  demon- 
strations dealing  with  the  common,  nay  universal,  phenomena 
of  syphilis,  feeble-mindedness,  epilepsy  alcoholism,  and  even 
somewhat  concerning  the  obscure  field  of  the  so-called  psycho- 
pathic personalities. 

Of  course  the  social  worker  might  readily  get  beyond  the 
range  of  everyday  medical  practitioner  in  these  regards,  at 
all   events   if  we  consider   the   medical  practitioner   of   elder 


556  THE    KINGDOM    OF    EVILS 

vintages.  But  this  comparison  is  a  bit  odious  and  it  is  cer- 
tainly not  the  duty  of  those  who  make  the  curricula  of  schools 
for  social  work  to  dampen  their  ardor  just  because  medical 
schools  have  grievously  neglected  psychiatry. 

Another  question  of  deeper  interest  to  the  close  student 
of  mental  hygiene  is  the  question  whether  there  ought  not 
to  be  special  schools  or  curricula  that  deal  with  psychiatric 
social  work  with  the  endeavor  to  produce  a  special  brand  of 
social  workers, — ^psychiatric  social  workers.  It  is  a  matter 
of  history  that  Smith  College,  with  the  assistance  of  Dr. 
Spaulding,  the  New  York  School  of  Social  Work  through 
Dr.  Glueck,  and  the  Pennsylvania  School  for  Social  Service 
through  Dr.  Taft  did  actually  develop  courses  for  training 
psychiatric  social  workers.  These  courses  were  developed 
during  the  war  fervor.  They  attracted  and  are  attracting 
women  as  a  rule  with  college  degrees  with  very  special  interests 
in  the  humanities  and  with  a  point  of  view  perhaps  a  bit  less 
economic  than  the  point  of  view  of  the  ordinary  social  worker. 
The  infusion  of  this  blood,  a  little  more  radical  and  fiery  than 
the  sober  reform  blood  of  the  type  of  social  worker  familiar 
to  us  all,  no  doubt,  will  have  some  rather  surprising  results, 
but  we  think  the  advantages  of  novelty  and  freshness  of  point 
of  view  may  counterbalance  the  disadvantage  of  oversobriety 
and   conservatism. 

The  comparative  youth  of  sociology,  of  applied  sociology 
(social  work),  of  applied  medical  sociology  (medical  social 
work),  and  of  the  putative  new  branch  (psychiatric  social 
work)  entails  a  certain  fluidity  of  nomenclature  at  first  not 
unserviceable.  Nor  would  it  be  necessary  or  even  desirable 
to  fix  at  the  outset  a  nomenclature  for  logical  compartments 
of  an  undeveloped  art,  as  we  might  thus  condemn  the  art  to 
stasis  or  bad  cuh-de-sac.  We  raise  the  question,  therefore, 
only  on  the  practical  ground  of  whether  or  no  specialists,  pro- 
fessional or  technical,  have  been  developed  or  are  in  course  of 
development  in  this  field  of  sociology.  For,  if  so,  that  is,  if 
the  new  art  has  found  its  shoulder-to-shoulder  workers,  then 
it  is  high  time  to  state  the  principles  of  their  alignment,  and 
the  nature  of  curricula  and  practical  experience  necessary  for 
these  workers. 

We  assume  that  medicine  and  applied  sociology  are  profes- 
sions with  their  professors  and  practitioners  having  due  recog- 


THE    KINGDOM    OF    EVILS  557 

nition  in  university  degrees,  M.D.  and  Ph.D.,  respectively, 
and  in  commonly  accepted  titles,  physician  and  sociologist. 
On  account  of  the  recency  of  sociology's  foundation,  every- 
body is  prepared  to  accord  to  many  workers  without  the  degree 
Ph.D.  just  as  good  and  perfectly  equivalent  dignity.  Nor 
should  such  a  contention  as  that  sociologists  will  more  and 
more  tend  to  be  Ph.D.  bearers  be  regarded  as  propaganda  of 
Professor  James'  "Ph.D.  octopus,"  since  everybody  is  now 
aware  that  novelty,  in  medicine,  sociology,  or  any  other  branch, 
is  perhaps  more  likely  than  not  to  come  from  some  distant 
science.  Thus  the  teaching  branches  of  medicine  are  more 
likely  to  get  novelty  from,  e.g.,  chemistry,  or  physics,  than 
from  their  own  more  limited  fields.  And  the  teaching  branches 
of  applied  sociology  are  very  likely  to  profit  more  from 
anthropology  or  psychology  than  from  the  recognized  rounds 
of  sociological  research  as  narrowly  conceived,  e.g.,  in  the  field 
of  social  statistics.  Perhaps  even  it  might  be  said  that  many 
branches  of  didactic  medicine  and  sociology  would  get  more 
food  for  new  thought  from  each  other  than  each  from  itself. 
We  are  not  here  talking  of  the  technique  of  research,  but  of 
the  sort  of  training  which  allows  us  to  concede  that  such  and 
such  a  person  is  entitled  to  rank  as  a  professional  sociologist 
alongside  the  physician. 

There  are,  to  repeat,  persons  to  whom  we  accord  an  equal 
professional  rank  as  didactic  or  practical  masters  of  their 
fields — physicians  and  sociologists.  But  every  profession  must 
develop  apprentices  or  ancillary  workers  of  various  sorts.  Thus 
medicine  has  developed  the  nurse.  Applied  sociology,  we 
make  bold  to  say,  has  developed  quite  on  the  same  level — 
the  social  worker.  One  has  to  be  bold  For  many  social 
workers,  perfectly  modest  as  to  their  own  private  capacities, 
have  developed  a  surprising  group-consciousness  concerning 
the  proper  dominance  of  the  ideal  social  worker  in  all  social 
maladjustments.  This  group-consciousness  of  social  workers 
often  leads  to  a  not  unwarranted  derision  on  the  part  of  physi- 
cians, judges,  men  of  the  world.  The  point  here  is  probably 
simple:  just  because  not  every  eminent  sociologist  is  a  Ph.D. 
and  because  many  sociologists  prefer  to  call  themselves 
"workers"  (from  the  American  habit  of  denouncing  theory 
and  suspecting  all  "-ologists"  of  carrying  lugs),  many  humbler 
persons  conceive  that  there  is  no  theory  behind  their  prac- 


558  THE    KINGDOM    OF    EVILS 

tice,  no  sociology  behind  their  social  service.  It  is  as  if,  on 
the  one  hand,  physicians  seeing  that  medicine  is  so  much  a 
matter  of  nursing  should  announce  themselves  as  a  kind  of 
nurse;  it  is  as  if,  on  the  other  hand,  nurses  seeing  that  the 
physicians  are  so  ignorant  of  many  practical  matters  should 
suddenly  conceive  that  nurses  were  after  all  a  sort  of  physi- 
cian. Practically,  too,  in  the  present  phase  of  social-service 
development,  social  workers  are  apt  to  be  of  a  finer  grain  and 
a  more  finished  higher  education  than  the  majority  of  nurses, 
and  accordingly  the  social  workers  are  inclined  to  develop  a 
feeling  of  group-superiority  to  nurses.  This  attitude  is  of 
course  a  matter  of  dispute  as  to  its  justifiability,  but  is  none 
the  less  existent.  But  we  conceive  that,  unless  a  person  wishes 
to  go  to  the  length  of  special  training  of  professional  grade, 
he  can  hardly  claim  equivalence  to  a  man  of  professional 
training.  We  conceive  that  professionally  trained  social 
workers,  of  the  Ph.D.  level  or  equivalent,  will  finally  admit 
themselves  to  be  sociologists,  albeit  applied  sociologists.  And 
we  hope  that  further  there  will  be  a  group-consciousness  de- 
veloped of  social  workers  iDelow  the  "-ologist"  grade  with 
an  attitude  resembling  that  of  nurses  to  their  work — an  atti- 
tude, according  to  temperament,  of  humble  pride  or  proud 
hum.ility  with  respect  to  their  acknowledged  leaders,  the  ap- 
•^lied  sociologists.  Nor  should  the  term  profession  be  made  a 
stumbhng-block :  if  nursing  is  a  profession,  so.  ought  social 
work  (below  the  level  of  sociology)  to  be  ackno^vledged  a  pro- 
fession also :  this  last  is  a  matter  of  terms  only. 

But  no  two  sciences  or  arts  can  in  these  days  long  exist 
without  fruitful  contacts.  Pathological  and  sociological  prog- 
ress have  gone  hand  in  hand.  Many  a  physician  is,  we  say, 
really  and  by  temper  a  sociologist :  many  a  sociologist  develops 
so  deep  an  interest  in,  e.g.,  sanitation  problems  that  he  becomes 
in  effect  a  physician,  at  least  an  expert  in  public  health. 
Social  medicine  and  medical  sociology  have  much  in  common : 
either  could  receive  the  term  theory  of  the  public  health 
without  special  error  of  definition. 

Not  to  linger  over  the  definition  of  public  health,  hygiene, 
and  preventive  medicine  as  against  the  non-medical  branches 
of  sanitary  science  and  art,  it  is  clear  that  both  social  medi- 
cine and  medical  sociology  have  brought  to  life  auxiliary 
groups  of  practical  workers,  viz.,  the  public  health  nurse  and 


THE    KINGDOM    OF   EVILS  559 

the  medical  social  worker.  It  is  clear,  too,  that  just  as 
social  medicine  and  medical  sociology  are  different  in  their 
points  of  view,  so  the  aides  in  the  practical  work  of  each  field 
are  likely  to  have  a  different  point  of  view.  If  the  lively 
growth  of  the  public  health  nurse  group  sometimes  threatens 
to  engulf  the  medical  social  worker  {e.g.,  by  proposals  that 
the  same  curriculum  will  do  for  both),  the  fact  is  that  no 
such  forced  union  will  ever  take  place,  judging  by  the  quality 
and  nature  of  the  persons  each  field  has  so  far  attracted. 

Now  it  is  obvious  that  the  public  health  nurse  of  today  is 
no  better  prepared  to  be  an  aide  to  a  psychiatrist  than  the 
ordinary  physician  is  trained  to  deal  with  psychopathic  cases. 
Should  there  not  be  a  group  of  nurse-like  human  beings  who 
should  be  aides  to  psychiatrists  in  much  the  same  sense  as 
public  health  nurses  are  aides  to  the  public  health  physicians? 
On  the  other  hand,  should  not  there  be  a  special  group  of 
social  workers  skilled  in  the  psychiatric  side  of  medical  soci- 
ology? Such  a  trained  mental  hygiene  aide  would  be  then  an 
assistant  to  the  psychiatrist  in  medical  treatment, — a  special 
type  of  public  health  nurse  trained  in  the  care  of  mental  dis- 
eases. She  would  be  equipped  with  an  understanding  of  social 
conditions  and  remedies  to  the  extent  that  such  appreciation 
of  social  problems  has  been  found  desirable  for  the  public 
health  nurse.  She  should  not  be  confused  with  the  psychi- 
atric social  worker  whose  function  is  to  assist  in  social  diag- 
nosis and  treatment  under  sociological  direction.  In  short,  we 
think  it  will  be  possible  to  show  that  the  point  of  view  of 
medicine  and  the  point  of  view  of  social  work  are  at  bottom 
sundered  from  each  other,  so  that  the  physician  and  the 
sociologist,  the  nurse  end  the  social  zvorker,  the  mental  hygiene 
aide  and  the  psychiatric  social  worker,  will  always  remain  per- 
sons with  somewhat  separate  sentiments.  It  is  worth  while 
to  insist  that  these  sentiments  though  separate  are  not  neces- 
sarily opposed  to  one  another.  It  is  even  possible  that  within 
a  single  personality  a  worker  can  be  an  effective  individualist, 
on  the  one  hand,  and  an  effective  social-groupist,  on  the  other ; 
that  one  can  be  both  a  physician  and  an  applied  sociologist 
successfully;  but  the  success  attained  will  probably  be  like  that 
in  which  the  right  (or  medical)  hand  will  not  know  what  the 
left  (or  social)  hand  is  doing. 

So  much  for  our  theory  of  the  future  of  education  for  psy- 


560  THE    KINGDOM    OF    EVILS 

chiatric  social  work.  The  present  practice  follows  a  middle 
course, — the  trained  psychiatric  social  woricer  today  is  not, 
as  a  rule,  the  applied  sociologist  of  Ph.D.  grade,  nor  yet  the 
practical  worker  bearing  the  same  relation  to  sociology  that 
the  nurse  bears  to  medicine,  but  something  of  both. 

The  special  training  courses  for  psychiatric  work  now  given 
in  several  schools  (Smith  College  Training  School  for  Social 
Work;  New  York  School  of  Social  Work;  Pennsylvania 
School  for  Social  Service)  are  graduate  courses  covering  a 
period  of  approximately  two  academic  years.  Such  courses 
approach  the  requirements  for  the  A.M.  degree.  There  are 
persons  who  think  that  the  degrees  A.M.  and  Ph.D.  may  not 
reasonably  be  offered  in  social  work  on  the  ground  that  such 
education  is  practical  rather  than  scientific.  Even  if  it  be 
granted  that  social  work  is  a  form  of  applied  science,  there 
are  probably  forces  at  work  in  a  good  many  universities  and 
colleges  that  regard  with  suspicion  all  science  that  has  the 
flavor  of  practicality. 

To  meet  the  demand  for  social  workers  for  the  neuropsy- 
chiatric  hospitals  of  the  army,  the  plan  of  the  Smith  College 
Training  School  of  Psychiatric  Social  Work  was  conceived 
by  us,  in  191 8,  as  a  war-emergency  course.  Intensive  courses 
of  instruction  were  given  at  Smith  College  during  eight  weeks 
of  the  summer,  and  the  students  were  then  distributed  among 
four  cities — Boston,  New  York,  Philadelphia,  and  Baltimore 
— for  six  months  of  practice  work  in  various  hospitals  and  so- 
cial agencies.  Some  experienced  social  workers  were  admitted 
for  the  summer  course  only.  The  following  year  Smith  Col- 
lege continued  the  course  as  a  permanent  school  under  the 
name  of  the  Smith  College  Training  School  for  Social  Work. 
The  length  of  the  course  was  changed  from  eight  to  thirteen 
months,  and  training  for  other  branches  of  social  work  also  was 
undertaken.  The  work  falls  into  three  divisions — a  summer  ses- 
sion of  eight  weeks  of  theoretical  instruction  combined  with 
clinical  observation;  a  training  period  of  nine  months  of  study 
and  practice  carried  on  in  cooperation  with  hospitals ;  and  a 
concluding  summer  session  of  eight  weeks  of  advanced  study. 
The  summer  sessions  are  held  at  Smith  College,  Northampton, 
Massachusetts.  The  practical  instruction  is  arranged  by  plac- 
ing students   with   hospitals   in  different   cities,   under   super- 


THE    KINGDOM    OF    EVILS  561 

vision,  locally  and  centrally,  by  the  staff  of  the  Training 
School. 

This  method  of  preliminary  instruction  followed  by  con- 
tinuous practice  was  the  outgrowth  partly  of  the  necessity  for 
training  quickly  a  larger  number  of  workers  than  could  be 
provided  with  practice  facilities  in  any  one  city,  and  also 
partly  of  our  experience  with  an  apprentice  course  given  for 
several  years  at  the  Psychopathic  Hospital.  We  found  that 
a  student  who  was  on  duty  continuously,  giving  full  time  to 
case  work  without  the  distraction  of  class  work,  acquired  ex- 
perience and  skill  more  quickly  and  more  confidently.  If  the 
student  gives  full  time  in  the  hospital,  is  on  duty  regularly 
and  without  interruption,  she  becomes  completely  assimilated 
into  the  organization  and  so  gains  in  depth  of  experience  as 
well  as  in  drill  and  discipline.  Moreover,  a  student  who  has 
received  preliminary  instruction  can  from  the  beginning  do 
more  responsible  case  work.  It  is  doubtful  whether  prac- 
tice work  with  social  cases  can  be  carried  on  satisfactorily 
along  with  intensive  instruction,  for  human  problems  cannot 
be  regulated  so  that  experience  will  run  parallel  to  theoretical 
instruction.  On  the  other  hand,  the  concentration  of  study  in 
two  periods  at  the  beginning  and  end  of  the  practice  work 
permits  a  high  degree  of  mental  application.  A  thread  of 
theory  running  through  the  practice  period,  in  the  form  of  a 
weekly  class,  required  reading,  and  preparation  of  a  thesis, 
serves  to  unite  the  two  study  periods. 

The  potential  student  then  should  in  the  first  place  be  a 
somewhat  educated  person,  that  is,  the  possessor  of  an  A.B. 
degree  or  else  equally  well  educated  by  less  formal  methods 
than  a  full  college  course.  She  will  need  both  the  qualities 
requisite  for  all  forms  of  intellectual  work  and  the  qualities 
requisite  for  all  forms  of  practical  work.  Further,  she  must 
have  the  qualities  that  all  social  work  requires — interest  in 
individuals  and  a  liking  to  follow  them  into  the  scenes  of  their 
daily  lives,  an  impersonal  attitude,  the  power  of  intelligent 
sympathy,  a  high  degree  of  disinterestedness,  and  the  capacity 
for  sustained  purpose.  In  addition,  the  special  qualifications 
that  the  psychiatric  social  work  requires  in  a  marked  degree 
are  patience,  analytical  ability,  and  capacity  for  objective 
observation. 


562  THE    KINGDOM    OF    EVILS 

A  course  in  preparation  for  psychiatric  social  work  presup- 
poses the  college  branches — biology,  psychology,  sociology, 
economics,  and  government.  The  content  of  the  special  grad- 
uate course  given  at  the  Smith  College  Training  School  in- 
cludes social  psychiatry,  the  theory  of  mental  tests,  the  essentials 
of  medicine,  social  psychology,  government  as  related  to  social 
work,  organization  of  social  work,  and  the  theory  and  practice 
of  social  case  work.  Theoretically  it  might  seem  desirable  to 
add  such  a  course  to  a  foundation  of  one  year  in  general  social 
work,  where  the  student  would  acquire  the  technique  of  social 
case  work  and  a  knowledge  of  the  organization  of  social  work. 
But  there  is  reason  to  think  that  the  best  results  are  obtained 
at  present  by  admitting  students  at  once  to  specialized  training. 
Schools  of  social  work  have  not  in  the  past  given  a  place  in  their 
general  training  to  principles  of  mental  hygiene,  so  that  train- 
ing in  social  work  is  apt  to  be  deficient  in  the  psychiatric  point 
of  view,  which  it  is  desirable  for  the  student  in  psychiatric 
social  work  to  acquire  as  early  as  possible. 

Principles  and  technique  of  case  work  may  be  acquired  as 
readily  in  psychiatric  cases  as  elsewhere.  Nor  is  the  experi- 
ence of  the  student  working  on  psychiatric  cases  limited  to 
psychopaths,  for  all  the  members  of  the  family  come  within 
the  field  of  action. 


A   NOTE   UPON   LEGAL   ENTANGLEMENT   AS   A 
DIVISION   OF  EVIL 

RoscoE  Pound 

In  civilized  society  the  individual  must  adjust  not  only  to  his 
fellowmen  and  to  groups  of  his  fellowmen  but  to  the  political 
organization  of  society  and  to  the  legal  order.  Maladjustments  in 
the  latter  respect,  whether  due  to  fault  of  the  individual  or  inde- 
pendent of  his  fault,  whether  inevitable  because  of  inherent  diffi- 
culties in  the  administration  of  justice  through  law  or  remediable 
by  improved  and  better-operated  legal  machinery,  are  Litigia  in 
Dr.  Southard's  sense.  Briefly,  he  means  forms  of  social  malad- 
justment involving  contacts  with  the  law.  For  he  conceives  rightly 
that  mere  involvement  in  a  legal  controversy  is  an  evil,  and  an  evil 
to  which  we  are  naturally  subject  in  society  quite  as  much  as  to 
disease  or  to  poverty.  The  legal  machine,  like  any  other  machine, 
in  the  nature  of  things  will  operate  mechanically,  and  in  that 
mechanical  operation  the  just  as  well  as  the  unjust  are  likely  to 
be  caught. 

Conditions  of  controversy  and  legal  entanglement  may  be  ag- 
gravated by  or  may  result  from  some  of  the  other  main  types  of 
evil.  But  as  disease  or  poverty  or  ignorance  may  be  of  inde- 
pendent non-culpable  origin,  so  conditions  of  controversy  or  legal 
entanglement  may  arise  quite  without  fault  of  him  who  suffers 
therefrom.  Moreover,  whether  we  turn  to  the  reported  decisions 
of  the  courts,  or  to  the  reports  of  legal  aid  societies  or  to  the 
accounts  of  actual  experience  of  judicial  administration  of  justice 
which  lawyers  have  put  in  the  form  of  fiction,  we  may  find  abun- 
dant testimony  that  those  who  for  any  reason  become  entangled  in 
legal  controversy  may  suffer  as  acutely,  without  moral  fault  on 
their  part,  from  evils  not  easily  separable  from  our  social  and 
political  and  legal  organization  as  their  fellows  who  are  burdened 
with  disease  or  poverty,  or  ignorance.  In  Ten  Thousand  a  Year 
and  in  Farmer  Bumpkin's  Law  Suit,  two  lawyers  have  painted 
in  enduring  colors  what  it  means  to  be  a  party  to  a  hard  fought 
law  suit.^    The  story  may  be  told  no  less  vividly  from  the  actual 

^  The  effect  of  protracted  litigation  in  paralyzing  the  energies  and  sap- 
ping the  vitality  of  a  litigant  is  set  forth  by  Dickens  in  Bleak  House 
and  by  George  Eliot  in  The  Mill  on  the  Floss, 

563 


564  A    NOTE    UPON    LEGAL   ENTANGLEMENT 

records  of  the  courts.  No  doubt  the  social  worker  encounters  legal 
entanglement  as  a  complication  in  cases  primarily  involving  other 
evils.  But  it  may  serve  better  to  demonstrate  Dr.  Southard's  point 
if  we  look  exclusively  at  cases  of  legal  entanglement  pure  and 
simple  or  cases  where  involvement  in  legal  controversy  is  the  pri- 
mary factor. 

One  may  find  himself  seriously  involved  in  legal  controversy, 
without  fault  on  his  part,  either  as  a  matter  of  pure  misfortune  or 
as  the  victim  of  the  culpable  action  or  inaction  of  others.  In  the 
first  category  (pure  misfortune)  four  all  too  common  cases  may 
be  noted :  mistaken  identity,  circumstantial  evidence,  the  chance 
that  one  may  be  a  casual  eyewitness  of  another's  crime,  and  in- 
heritance of  a  bona  fide  litigated  claim.  The  case  of  Lesurques,^ 
positively  identified  by  numerous  witnesses  and  executed  for  a 
crime  of  which  the  event  showed  he  was  wholly  innocent  and  for 
which  the  real  perpetrator  was  afterwards  brought  to  justice,  and 
of  Adolf  Beck,^  twice  convicted  and  subjected  to  imprisonment  for 
crimes  with  which  he  had  absolutely  no  connection  upon  mistaken 
identifications  by  the  victims  and  only  saved  by  the  apprehension 
of  the  real  offender  for  like  crimes  committee  while  Beck  was 
in  custody,  stand  out  in  the  annals  of  the  criminal  law.  But 
Lesurques  and  Beck  were  men  of  a  certain  social  position,  of  edu- 
cation and  of  some  means.  How  many  such  cases  occur  where  the 
accused  cannot  invoke  such  resources  and  thereby  bring  the  in- 
justice to  light  we  may  but  conjecture.*  At  the  very  least  we  must 
admit  a  potential  danger  of  legal  entanglement  through  mistaken 
identity  as  something  never  to  be  overlooked.  How  an  innocent 
person  may  be  the  victim  of  appearances  and  of  circumstantial 
evidence  has  been  a  fruitful  theme  for  dramatists  and  novelists 
and  is  continually  illustrated  in  the  courts,  despite  all  provisions 
for  careful  deliberate  trial  of  the  facts  and  presumptions  of  inno- 
cence.^  Less  serious,  but  bad  enough,  is  the  condition  of  the  up- 
right and  busy  or  upright  but  indigent  citizen  who  chances  to  be 
an  important  witness  to  the  commission  of  a  felony.  Mr.  Train 
has  told  us  from  first-hand  observation  what  the  witness  must  go 

^  As  to  Lesurques,  see  Fouquier,  Caiuses  cclchres  de  tons  les  peuples, 
III,  no.  12;  I  Green  Bag,  72. 

*  See  Report  of  the  Committee  of  Inquiry  into  the  Case  of  Mr.  Adolf 
Beck,  1904.  Not  only  was  Beck  imprisoned  for  crimes  with  which  he  had 
no  connection,  but  he  lost  his  property  through  inability  to  preserve  it  while 
in  prison. 

*  For  the  more  notable  older  cases  of  mistaken  convictions,  see  Loeiifler, 
Die   Opfer  mangelhaftcr  Justic,  3  vols.,  Jena,   1879. 

"Examples  are  collected  in  Hellwig,  Jtisticirrtiimer,  1914.  For  an 
American  case,  see  People  v.  Tcipcr,  186  App.  Div.  830.  Teiper  was  ac- 
quitted upon  a  retrial. 


A    NOTE    UPON    LEGAL    ENTANGLEMENT  156  ^ 

through  with  if  he  is  able  to  give  sureties  to  appear  and  testify.^ 
If  he  cannot  give  security,  he  is  likely  to  be  committed  to  jail  to 
secure  his  appearance  as  a  witness  and  to  suffer  almost  as  much 
as  if  he  had  actually  offended."  But  it  is  quite  as  possible  to  be 
caught  innocently  in  the  mill  of  civil  litigation.  One  type  of  case 
is  inheritance  of  a  bona  fide  litigated  claim.  Dickens  pictured  what 
this  means  in  Jarndyce  v.  Jarndyce,  and  the  Gaines  case  in  the 
United  States  may  serve  to  show  how  impossible  it  is  for  fiction 
to  rival  fact.  The  litigation  which  occupied  the  whole  of  her  long 
life  came  to  Mrs.  Gaines  as  an  inheritance  in  1813.  In  1886  she 
died  at  the  age  of  eighty  and  bequeathed  it  to  her  grandchildren, 
having  outlived  her  children.  In  1891  it  finally  came  to  an  end 
and  the  inheritance  for  which  she  had  struggled  all  her  days  came 
to  her  heirs.  In  the  meantime  the  case  had  been  fourteen  times 
before  the  Supreme  Court  of  the  United  States  and  had  been 
fourteen  times  before  the  highest  state  court  or  the  United  States 
Circuit  Court  on  points  of  sufficient  importance  to  call  for  reported 
opinions.^  The  reports  are  full  of  cases  of  which  the  Gaines  case 
is  but  an  extreme  example.^ 

As  to  the  second  category  (cases  where  one  is  the  innocent  vic- 
tim of  the  fault  or  default  of  others)  at  least  seven  important 
types  are  of  common  occurrence,  (i)  Cases  are  legion  in  which 
the  innocent  have  been  drawn  into  ruinous  litigation  because  of 
judicial  vacillation.  Thus  the  chronicler  of  the  Gaines  case  tells 
us :  "The  decision  in  12  Howard  being  thus  overthrown  by  this 
last  decision,  ruin  was  the  consequence  to  many  who  confided  in 
its  soundness  and  purchased  ...  on  the  faith  of  that  decision."  ^° 

*  Train,  The  Prisoner  at  the  Bar,  chap.  7,  entitled,  "If  the  Cook  Should 
Steal  the  Teapot. 

'  California  endeavored  to  meet  this  situation  by  a  constitutional  pro- 
vision that  witnesses  should  not  be  unreasonably  detained.  Under  that 
provision  it  was  held  that  a  witness  might  be  released  on  habeas  corpus 
after  he  had  been  held  for  ninety  days  and  the  hearing  of  the  prosecution 
had  been  put  off  repeatedly.  Ex  parte  Dressier,  67  Cal.  257.  Compare  Ex 
parte  Petrie,  i  Kan.  App.  184. 

*  See  Payne,  A  Celebrated  Case,  14  Rep.  Georgia  Bar  Association,  219, 
'E.g.,  the  case  of  Patience  Swinfen,  a  widow  whose  father-in-law  left 

her  his  property  as  a  tardy  reparation  for  driving  his  son  from  home  at  the 
time  of  his  marriage.  Nine  years  of  litigation,  involving  ten  reported  deci- 
sions, were  required  to  enable  her  to  hold  the  property.  See  Burnham, 
Some  Famous  Litigants,  6  Green  Bag,  399,  400-402.  For  an  American  case, 
see  Giles  v.  Little,  2  McCrary  370;  Giles  v.  Little,  104  U.  S.  291 ;  Little  v. 
Giles,  118  U.  S.  596;  Little  v.  Giles,  25  Neb.  313;  Little  v.  Giles,  27  Neb. 
179;  Giles  V.  Little,  134  U.  S.  645;  Chase  v.  Miles,  43  Neb.  686;  Lincoln 
Transit  Co.  v.  Rundle,  34  Neb.  550;  Roberts  v.  Lewis,  134  U.  S.  153 — 
thirteen  years  of  litigation  over  the  meaning  of  a  gift  to  a  widow  in  her 
husband's  will. 

'"  14  Rep.  Georgia  Bar  Association  239.  Compare :  "But  in  the  mean- 
time many  whose  purses  were  not  long  enough  to  keep  up  the  fight  yielded 


566  A    NOTE    UPON    LEGAL    ENTANGLEMENT 

(2)  Again  the  mere  delay  which  is  too  common  in  all  litigation, 
may  be  aggravated  to  the  substantial  ruin  of  litigants.^^  (3)  One 
may  be  involved  in  protracted  and  even  ruinous  litigation  through 
the  roguery  of  a  plausible  impostor.  The  Tichborne  case  in 
England,  ^yhich  charged  a  goodly  inheritance  with  a  burden  for 
generations  to  come,  is  the  classical  example.  But  the  United 
States  may  furnish  examples  of  its  own.^^  (4)  One  may  also  be 
the  victim  of  a  protracted  prosecution  based  on  false  testimony 
adduced  to  shift  responsibility  from  the  guilty  to  the  innocent. ^^ 
(5)  Again  one  may  be  the  victim  of  governmental  dishonesty  and 
be  compelled  to  spend  his  days  in  vain  endeavors  to  procure  justice 
from  a  state  that  cannot  legally  be  compelled  to  pay  its  just  obli- 
gations.^* (6)  One  of  the  most  common  types  is  willful  aggres- 
sion which  compels  him  whose  rights  are  infringed  to  engage  in 
prolonged  and  expensive  litigation  whether  he  will  or  no.  Thus 
it  often  happens  that  the  victim  of  a  malicious  defamation  or  a 
malicious  prosecution  must  vindicate  his  reputation  and  his  honor 
in  order  to  live  a  human  life  among  his  fellowmen.  A  striking 
instance  of  what  this  may  involve  is  afforded  by  the  well-known 
Jones  County  Calf  Casc}^  In  that  case  a  farmer  who  had  been 
maliciously  prosecuted  by  an  organization  found  himself  entangled 

to  judgments  in  ejectment  in  the  federal  court  based  on  the  first  opinion  in 
the  federal  Supreme  Court,  and  sued  their  grantors  upon  covenants  of  war- 
ranty. As  these  grantors  had  not  felt  able  to  continue  the  litigation,  they 
were  compelled  to  pay  damages,  although,  in  the  event,  they  had  conveyed 
a  good  title."  Pound,  Principles  of  Procedural  Reform,  4  Illinois  Law 
Rev.  491,  492-494  (referring  to  the  litigation  described  at  the  end  of  note  9). 

""Hundreds  of  causes  were  remaining  to  be  heard;  thousands  of 
suitors  had  abandoned  proceedings,  and  many  were  ruined  under  grievous 
oppression  merely  because  they  were  unable  to  afford  the  money  or  the  time 
necessary  to  enable  them  to  proceed.  Even  those  who  found  the  means  and 
expended  the  money  and  time  necessary  to  get  their  causes  ready  for  hear- 
ing, were  kept  in  suspense  for  an  unreasonable  length  of  time,  uncertain 
whether  they  were  thereafter  to  be  rich  or  poor;  many,_  f  rom  the  tardy 
steps  of  justice,  were  unable  to  form  or  settle  their  plans  in  life,  and  were 
kept  in  a  state  of  the  most  harassing  wretchedness."  Duffus  Hardy,  Life 
of  Lord  Langdale,  I,  349. 

"E.g.,  Flora  v.  Anderson,  75  Fed.  217.  For  a  sketch  (founded  on 
fact)  of  the  position  in  which  innocent  persons  may  be  put  by  a  plausible 
impostor,  see  Mark  Twain,   The  Major's  Story. 

"Those  who  have  studied  the  case  attentively  believe  the  Frank  case  to 
be  one  of  this  sort.    See  Connolly,  The  Truth  about  the  Fralnk  Case,  1915. 

"  Mark  Twain  has  given  us  a  picture  of  the  condition  of  such  a  victim 
in  The  Great  Beef  Contract.  See  Fleischmann,  The  Dishonesty  of  Sov- 
ereignties, 22  Rep.  N.  Y.  State  Bar  Association  (1910),  229.  Compare  the 
twenty-six  years  of  litigation  to  which  holders  of  coupons  of  Virginia  bonds 
were  subjected,  McCullough  v.  Virginia,  172  U.  S.  102,  and  prior  cases  set 
forth  in  the  opinion  of  Mr.  Justice  Brewer. 

^Proceedings,  Iowa  State  Bar  Association    (1920),   141-156. 


A    NOTE    UPON    LEGAL    ENTANGLEMENT  567 

in  twenty-five  years  of  bitter  litigation  and  was  able  to  clear  his 
character  only  through  persistence  under  discouragements  which 
would  have  worn  out  an  ordinary  litigant.  (7)  Finally  there  are 
cases  of  what  may  be  called  parasitism — cases  where  swindlers  and 
extortioners,  who  have  learned  the  possibilities  of  using  the  ma- 
chinery of  the  law  as  a  means  of  oppression,  deliberately  involve 
their  victims  in  legal  entanglements,  in  the  confidence  (often  but 
too  well  founded)  that  they  are  too  poor  or  too  ignorant  or  too 
busy  to  be  able  to  extricate  themselves  and  will  thus  become  an 
easy  prey.  The  reports  of  Legal  Aid  Societies  are  full  of  such 
cases. ^^  The  innocent  man  of  scanty  means  but  high  sense  of  duty 
who  seeks  to  help  a  near  relative  out  of  trouble  and  finds  himself 
caught  in  the  web  of  litigation,  the  wage-earner  whose  wages  are 
held  in  an  illegal  attachment  in  the  endeavor  to  take  advantage  of 
his  necessities  and  coerce  him  into  what  he  is  not  bound  to  do,  the 
innocent  victim  of  get-rich-quick  swindlers  who  invests  his  savings 
in  worthless  "securities"  and  finds  himself  involved  in  elaborate 
winding-up  proceedings,  the  loyal  friend  or  relative  who  becomes 
surety  for  a  borrower  from  an  unscrupulous  and  exacting  lender 
at  extortionate  interest — all  these  are  but  too  well  known. 

It  will  not  do  to  say  that  the  state  provides  an  elaborate  and 
expensive  machinery  for  administering  justice  and  that  the  law 
operates  to  prevent  conditions  of  controversy  with  one's  fellowman 
from  being  or  becoming  a  serious  type  of  evil.  Public  agencies  for 
preventing  or  suppressing  vice,  public  health  service,  public  poor 
relief  and  public  education  do  not  prevent  us  from  recognizing  that 
vice  and  disease  and  poverty  and  ignorance  are  evils  with  which 
civilization  must  contend.  Strife  is  one  of  the  oldest  evils  in  social 
history  and  is  the  one  toward  which  politically  organized  society 
first  directed  its  powers.  Yet  the  legal  order  has  but  mitigated  this 
evil.  It  is  by  no  means  abolished.  Moreover,  the  machinery 
which  the  state  has  set  up  to  obviate  strife  and  put  an  end  to 
controversies  has  many  possibilities  of  injury  for  the  innocent,  the 
unwary  and  the  impecunious.  In  part  these  possibilities  of  injury 
are  inseparable  from  legal  administration  of  justice ;  they  grow  out 
of  difficulties  of  proof  and  infirmities  of  judgment  which  are  in- 
cident to  human  action.  In  part  they  are  due  to  reparable  defects 
in  our  legal  system  and  judicial  organization.  In  either  event  con- 
ditions of  legal  entanglement,  involved  in  the  endeavor  of  the  state 
to  put  down  strife,  adjust  controversies,  and  administer  justice,  are 
not  the  least  of  the  evils  with  which  men  must  reckon  in  social 
life  and  of  which,  therefore,  the  social  worker  must  take  account. 

^^  See  Smith,  Justice  and  the  Poor,  gff. 


APPENDICES 


APPENDIX  A* 

Case  46 
PSYCHOPATHIC  HOSPITAL 

SOCIAL  SERVICE 
NUMBER     2004 
FILE   NUMBER   7938 

0.  P.  D.  NUMBER    3562       NAME     Harold  Gordon  t 

Residence     Soldiers'  Home,  Derby,  Mass. 

Correspondent     Mrs.  Bessie  Driscoll,  49  Glenwood  St.,  Chelsea 

Sex    M  Age    45                              Color    W. 

Civil  Condition     S  Place  and  Date  of  Birth     U.  S. 

Religion     P  Occupation     Steamfitter 

Time  in  Boston    45  In  Mass.    45                    In  U.  S.    45 

Previous  addresses 

When  known  to  social  service     1/16/18 
When  discharged  from  social  service    7/1 /i8 
Reason  for  being  known  to  social  service    Employment 
Report  from  confidential  exchange    No  record 

Name  of  father    George  Gordon 

Address    61  Jackson  St.,  Maiden,  Mass. 

Name  of  mother    Jennie  Drake 

Address     972  Irving  St.,  Chelsea,  Mass. 

Name  of  spouse 

Address 

Names  and  ages  of  children  or  siblings 


Admitted  to  house     1/4/17  Authority    Vol. 

Discharged     1/10/17  Admitted  to  O.  P.  D.     1/16/18 

Diagnosis     Luetic  hemiplegia ;  Condition 
Vascular  lues 

Social  symptoms  Date    2/5/18 

Cohabitation 
Industrial  disability 
Unemployment 

Social  diagnosis    Disease  Date     1/20/18 

*  These   case  records  are  printed  as  written    by   the   social   workers  without    revision, 
f  All  names  used  in  this  record  arc  fictitious. 


571 


^7^ 


APPENDIX    A 


PSYCHOPATHIC  HOSPITAL 

SOCIAL    SERVICE 
CASE    NO.    2004 

FILE  NO.  7938  NAME     Harold  Gordon 

ADDRESSES 
Patient: 

Soldiers'  Home,  Derby,  Mass. 
49  Glenwood  St.,  Chelsea. 

Relatives  and  friends: 

Brother-in-law,  George  Price, 

12  Newbury  St.,  Charlestown,  Mass. 

Brother-in-law,  Xavier  Price, 

27  Tuttle  St.,  Charlestown,  Mass. 

Patient's  mother,  Mrs.  Jennie  Gordon, 
972  Irving  St.,  Chelsea,  Mass. 

Patient's   father,  George  Gordon 
61  Jackson  St.,  Maiden,  Mass. 

Paternal  aunt,  61  Jackson  St.,  Maiden,  Mass. 

Employers: 
Mr.  Yale, 
SYz  Glenwood  Court,  Boston,  Mass. 

Young  &  Daniels, 

241  East  52nd  St.,  New  York  City. 

Mr.  David  F.  Hyde,  F.  Q.  Crawford  Co., 
Quint  St.,  Boston,  Mass. 

Patient's  wife's  employer: 
Mrs.  Howell, 
73  Quirk  St., 
Chelsea,  Mass. 

Patient's  wife: 

Bessie  Driscoll, 

49  Glenwood  St.,  Chelsea. 


APPENDIX    A 


573 


CASE   NO.   2004 
FILE    NO.   7938 


PSYCHOPATHIC  HOSPITAL 

SOCIAL    SERVICE 

NAME     Harold  Gordon 


EXPENSE  SHEET 


Paid 
1/23     Marriage  certificate. ..  .$  1.02 

1/29    Loan 50 

5/1       Wedding    11.00 


12.52 


Received 

2/6      From  patient $    .50 

5/1  "  "       i.oo 

S/io         "  "      11.02 


12.52 


CASE   NO.  2004 
FILE   NO.    7938 


PSYCHOPATHIC    HOSPITAL 

SOCIAL   SERVICE 

NAME     Harold  Gordon 


SUMMARY 
1918 

January  20. 
Social  History: 

Patient  is  a  single  American  man  45  years  old,  a  veteran  of  the  Spanish 
War.  He  lives  at  the  soldiers'  home,  Derby.  There  are  no  expenses 
incurred  there  and  patient  has  a  little  money  which  he  has  received  from 
the  Steamfitters'  Union.  Patient  is  a  steamfitter  by  trade  and  for  11 
years  prior  to  illness  worked  as  such,  making  approximately  $5  a  day. 
In  October,  1916,  patient  became  ill  and  as  a  result  now  drags  one  leg 
and  is  slow  and  awkward  on  his  feet.  Patient's  mother  lives  alone  on 
Irving  St.,  Chelsea,  having  3  small  tidy  rooms.  She  has  a  small  saving 
of  her  own.  Patient's  father  was  a  Civil  War  veteran.  Lives  with  his 
sister  in  Maiden,  Mass.  The  separation  from  his  wife  was  due  to  the 
fact  that  patient's  mother  wanted  him  to  go  to  Maine  to  live  with  his 
married  daughter.  Patient's  father  refused  and,  as  a  result,  patient's 
mother  went  to  Maine  without  him.  She  apparently  is  a  difficult  woman 
to  get  along  with  and  soon  friction  occurred  between  her  and  her  son- 
in-law  ;  as  a  result  she  came  back  to  Chelsea  and,  disliking  patient's  sister, 
has  refused  to  go  to  Maiden,     She   feels  that  her  husband  should  come 


574  APPENDIX    A 

to  her  and  says  that  his  pension  is  being  used  to  help  take  care  of  his 
sister.     Patient  visits  his  mother  every  little  while. 

Patient  has  been  having  sex  relations  w^ith  Mrs.  Driscoll,  a  widow 
with  a  daughter  13  yrs.  old.  She  lives  at  49  Glenwood  St.,  Chelsea. 
Patient  stays  two  or  three  nights  a  week  and  Mrs.  Driscoll  is  now  prob- 
ably pregnant  by  patient.  Patient  claimed  at  first  that  he  was  married, 
but  later  confessed  that  he  was  not.  Mrs.  Driscoll  does  housework  by  the 
day  two  or  three  days  a  week  and  her  brothers  pay  her  rent.  Her 
brothers  are  wealthy ;  one  owns  a  machine  and  is  manager  of  the  Hartford 
Tire  Company  on  Coolidge  St, 

Physical  History: 

October,  1916,  patient  had  a  shock  and  was  taken  to  the  City  Hospital. 
January,  1917,  patient  came  to  this  hospital  and  was  under  treatment  for 
neurosyphilis  and  has  reported  regularly  for  treatment.  He  claims  to 
have  had  syphilis  18  yrs.  ago.  When  patient  first  came  to  us  he  was 
practically  crippled  and  could  not  use  his  arms  or  legs  to  any  extent. 
Now  he  has  control  of  his  arms  and  control  of  one  leg.  He  must  report 
regularly  for  treatment. 

Mental  History: 

October,  1916,  patient  became  very  dizzy  and  confused;  felt  that  he 
might  throw  himself  into  a  furnace  when  he  attempted  to  throw  wood  in. 
He  was  admitted  to  this  hospital  in  January.  Shortly  after  his  admission 
his  confusion  subsided  and  there  have  been  no  returns  of  symptoms. 
Since,  he  has  apparently  been  a  steady  worker  and  faithful,  working 
better,  however,  as  an  assistant  than  when  sent  off  on  a  job  of  his  own. 
MN 


RESULTS 

January  18  to  April  18,  1918. 
Social: 

Patient  and  woman  with  whom  he  had  been  having  irregular  sex 
relations  were  married  February  9.  the  money  for  the  wedding  service 
being  loaned  by  the  Social  Service  Department.  Patient's  wife  was  ex- 
amined at  the  Boston  Dispensary  and  suspected  of  being  2  months'  preg- 
nant. Patient's  brother-in-law  feels  that  patient's  wife  has  always  been  a 
drag  on  them  and  they  wish  they  might  be  well  rid  of  her.  Felt  that  her 
marriage  would  merely  mean  one  more  person  to  support.  They  refuse  to 
assist  her  in  any  way  if  she  marries,  but  later  promised  visitor  that  if  she 
loaned  money  to  them  they  would  be  ready  to  pay  it  back  should  patient 
fail,  but  felt  they  should  at  first  be  made  to  understand  that  they  must 
stand  on  their  own  feet.  Patient  and  wife  have  moved  to  an  apartment  at 
5  Yale  Terrace;  the  rent  is  $35  a  month,  but  as  they  do  janitor  work  they 
receive  same  rooms  for  $20.  Work  has  been  obtained  for  patient,  F.  Q. 
Crawford  &  Co.,  and  patient  is  making  between  $17  and  $18  a  week.  He 
has  been  raised  and  is  now  second  to  the  foreman.  There  is  a  chance  for 
overtime  work  with  extra  pay,  but  patient  tires  easily  and  has  not  yet  done 
any  overtime. 

Physical: 

Patient  reports  regularly  for  treatment  and  is  improving. 


APPENDIX    A  575 

Mental: 

Patient  slowly  improving.  Feels  better  and  gets  tired  less  easily.  He 
hopes  soon  to  be  able  to  take  up  his  old  work  as  steamfitter.  He  has  had 
a  position  ofifered  to  him,  but  felt  that  he  should  not  undertake  it  just  yet. 
Patient  shows  poor  judgment,  especially  in  money  matters.  He  has  a 
happy  attitude  that  everything  will  be  all  right  and  will  occasionally  spend 
money  for  a  steak  and  be  obliged  to  borrow  money  for  food  the  next 
couple  of  days.  Patient  is  rather  proud  of  himself  for  having  stuck  by 
his  wife  and  married  her.  He  occasionally  will  say,  "H  I  hadn't  done  this 
for  Bessie  I  need  not  have  worked  ;  I  could  have  stayed  at  the  soldiers' 
home  all  my  life,  they  would  have  had  to  take  care  of  me."  On  the  other 
hand  patient  seems  proud  of  the  fact  that  he  is  able  to  support  a  home  and 
does  not  want  his  wife's  brothers  to  think  he  has  any  intention  of  sponging 
on  them. 
MN 


HISTORY 
1918 
January   16. 

Patient's  story:  Patient  and  alleged  wife.  Airs.  Bessie  Driscoll,  seen 
together  at  hospital.  Patient  states  that  he  is  living  at  the  Soldier's  Home 
in  Derby,  being  a  veteran  of  the  Spanish  War.  He  is  without  any  visible 
means  of  support.  His  wife  is  living  at  49  Glenwood  St.,  Chelsea.  She 
has  three  rooms,  for  which  her  two  brothers,  living  in  Charlestown,  pay 
$15  a  month  rent  for  her.  She  has  one  child,  now  11  years  old,  by  her 
first  husband.  Patient  claims  he  was  married  about  six  months  ago,  but 
cannot  give  the  exact  date  or  place  of  ceremony.  He  is  a  Protestant,  and 
his  wife  is  a  Catholic.  His  wife  claims  to  be  about  two  months  pregnant, 
at  least  she  has  had  no  menstrual  periods  for  the  past  two  months.  She 
talks  of  having  an  abortion,  but  apparently  has  no  real  intention  of  doing 
so. 

Patient  is  a  steamfitter  by  trade,  having  worked  steadily  for  Mr.  Yale, 
5H  Glenwood  Court,  Boston,  11  years  ago,  then  going  to  New  York  City, 
working  there  for  Young  and  Daniels,  for  10  years.  He  returned  then  to 
his  former  employer,  where  he  worked  until  he  was  taken  ill  in  October, 
1916. 

Patient  tells  of  how  crippled  he  was  one  year  ago, — even  six  months 
ago, — and  how  slowly  and  gradually  he  has  regained  the  use  of  his  arms, 
and  how  he  feels  encouraged  that  before  long  his  left  leg  will  be  cured. 

Names  and  addresses  of  friends  and  relatives  were  obtained.  Visitor 
promises  to  look  up  possible  openings  whereby  patient  may  make  use  of  his 
trade  without  the  undue  fatigue  which  would  occur  were  he  to  resume 
steamfitting. 

Patient  is  well  groomed,  pleasing  in  appearance,  affable  personality, 
though  somewhat  apathetic.  Mrs.  Driscoll  appears  nervous,  less  intel- 
ligent, and  less  attractive. 

January  18. 

Soldiers'  Home,  Derby,  Dr.  Pearson,  visited.  Informant  states  that 
patient  has  been  under  their  care  from  Jan.  25,  1917,  to  the  present  time. 
As  a  Spanish  War  Veteran,  he  is  entitled,  while  disabled,  to  receive  room 
and  board  free.    He  receives  no  pension,  but  is  permitted  to  leave  prac- 


5/6 


APPENDIX    A 


1918 

tically  whenever  he  requests.     Patient  as  a  rule  receives  a  pass  for  the 
duration  of  two  or  three  days  a  week. 

Informant  considers  patient  irresponsible,  claiming  that  he  put  him 
on  a  job  to  run  an  elevator,  the  pay  being  $8  a  month,  and  patient  went  ofif 
several  times,  leaving  the  elevator  with  no  one  to  man  it.  This  was  done 
in  spite  of  the  fact  that  informant  explained  to  him  how  embarrassing  it 
was  at  mealtime  to  have  no  elevator  in  order  to  assist  the  feeble  men  to 
and  from  their  meals.  Patient  seemed  indifferent,  and  after  three  or  four 
months  on  the  job,  informant  took  someone  else.  Informant  states  that 
it  will  be  nearly  impossible  to  find  work  for  a  man  of  patient's  type. 

January  18. 

Impression:  Somewhat  cynical,  but  willing  to  cooperate  in  any  pos- 
sible way. 

January  18. 

Employer,  Mr.  Yale,  5^  Glemvood  Court,  visited.  Informant  states 
that  patient  was  a  good  worker,  steady,  no  drinking,  and  that  he  would 
take  him  back  to-morrow  at  $5.50  a  day,  if  patient  would  come.  He  states 
that  patient  did  his  best  work  when  he  was  on  a  job  with  others.  If 
given  a  small  job  to  do  himself,  informant  felt  responsible  to  oversee  the 
job.  He  stated  that  probably  patient  could  not  take  charge  of  men,  but 
was  a  willing  and  energetic  and  fast  worker. 

hnpression:  Informant  seemed  to  have  no  interest  in  patient  as  an 
individual,  but  would  be  interested  if  patient  were  physically  able  to  work, 
as  there  is  a  great  demand  for  steamfitters  at  the  present  time, 

MN/S 

January  18. 

City  Hall  lisited.    No  record  of  marriage  certificate  is  recorded. 

January  18. 

Alleged  xvife,  Mrs.  Bessie  Driscoll,  49  Glemvood  St.,  visited. 

Informant  stated  that  she  had  known  patient  for  about  two  years,  and 
told  that  she  was  not  married  to  patient  of  her  own  accord.  During  this 
time  she  has  been  having  intercourse  with  patient,  and  claims  that  her 
standing  by  him  after  he  had  had  the  paralytic  stroke  is  one  big  factor  in 
patient's  recovery. 

Patient  visits  informant  about  once  a  week  for  a  period  of  two  or  three 
days.  Informant  claims  to  be  without  passion,  and  that  patient  is  very 
easily  excited.  Informant  states  that  she  does  cleaning  two  or  three  days 
a  week,  which  gives  her  $4  to  $5.  Her  two  brothers  pay  her  rent,  and 
their  wives  give  her  shirtwaists,  and  help  her  out  in  little  ways.  She  has 
one  child  dependent  upon  her.  Her  attitude  toward  her  brothers  is  that 
they  must  not  know  her  condition  until  after  she  is  married,  because,  as 
she  says,  "they  look  up  to  me,  and  know  I  know  better."  She  states  that 
they  are  better  educated  than  she  is, — that  they  went  to  High  School  and 
business  colleges.  She  went  only  as  far  as  the  8th  grade,  being  16  years 
old  when  she  left.  During  her  schooling  she  was  obliged  to  be  out  long 
periods  of  time  owing  to  illness  of  first  her  own  mother,  and  then  of  her 
step-mother.  Her  step-mother  died  when  she  was  16,  and  she  brought  up 
her  two  brothers.  Six  years  later  she  married,  and  two  years  later,  at  the 
time  of  her  confinement,  her  husband  was  electrocuted  at  work.  The 
brothers  take  the  little  girl  at  times,  as  for  vacations ;  and  once,  four  years 
ago,  when  informant  had  an  operation  at  the  Boston  City  Hospital  for 
fallen  womb.    As  soon  as  patient  is  able  to  work  informant  is  willing  to 


APPENDIX    A  577 

1918 

marry,  but  does  not  wish  to  give  up  $15  a  month,  three  attractive  rooms, 
etc.,  with  no  apparent  means  of  support  ahead.  She  feels  also  that  patient, 
who  has  a  big  appetite,  had  better  stay  at  the  Soldiers'  Home  until  he  gets 
work.  Informant  states  that  patient's  mother,  living  at  972  Irving  St., 
Chelsea,  is  very  hard  to  get  along  with.  She  calls  her  "an  indifferent,  old- 
fashioned  Yankee,  who  cares  more  for  the  dollar  than  for  anything  else." 
She  states  that  patient's  mother  is  jealous  because  she  feels  that  when 
patient  gets  to  work  he  is  going  to  give  money  to  informant  rather  than 
to  her.  Patient's  mother  has  a  small  income  of  her  own  which  enables 
her  to  be  independent.  Patient's  mother  was  in  Maine  visiting  her  only 
daughter.  Her  husband  refused  to  go  to  Maine,  and  he  is  now  living  with 
a  sister  in  Maiden. 

Second  impression:  Informant  seemed  excited  over  her  condition, 
not  for  her  own  sake  or  reputation,  but  because  of  her  family.  She 
appears  more  kind-hearted  and  intelligent  than  at  the  first  interview. 

January  23. 

Patient's  mother,  Mrs.  Jennie  Gordon,  9/2  Irving  St.,  Chelsea,  Mass., 
visited.  Informant  has  three  basement  rooms  in  a  congested  district,  but 
the  rooms  are  immaculately  neat — even  the  floor  looking  as  if  scrubbed 
daily.  Informant  is  a  frail,  delicate-appearing  woman.  She  gave  for  her 
reasons  for  living  alone  that  her  married  daughter's  husband  in  Maine  did 
not  really  want  her,  so  she  thought  she  would  come  back  to  Chelsea. 
She  went  to  see  her  husband  at  his  sister's,  61  Jackson  St.,  Maiden,  Mass., 
and  invited  him  to  come  and  live  with  her.  This  was  six  months  ago,  and 
he  has  never  been  to  see  her.  She  claims  that  he  is  feeble,  and  is  in- 
fluenced by  his  sister  who  wants,  and  probably  needs,  his  pension  of  ^33. 
He  is  a  Civil  War  veteran.  She  says  she  does  not  know  whether  or  not 
she  would  live  with  them  if  they  wanted  her  to.  She  has  small  savings  of 
her  own,  and  realizes  that  she  is  entitled  to  share  in  her  husband's  pension. 

Patient  was  spending  the  day  with  his  mother.  He  took  the  "laissez 
faire"  attitude  that  everything  would  be  all  right  when  he  went  to  work. 

Patient  walked  out  with  visitor,  and  was  asked  what  plans  he  had 
made  about  marriage,  etc.  He  promised,  to  see  "Bess"  and  talk  the  matter 
over  with  her. 

February  5. 

Brothers  of  patient's  fiancee,  George  and  Xazier  Price,  Hartford  Tire 
Co.,  851  Coolidge  St.,  visited.  George  is  the  manager  and  has  an  office  to 
himself.  Xavier  very  prosperous  looking.  Informants  stated  that  Mrs. 
Driscoll  had  never  been  able  to  support  herself,  and  that  they  had  for  years 
paid  her  rent  and  given  her  a  little  money  besides.  Stated  that  they  had 
no  use  for  patient,  felt  that  they  did  not  want  him  in  their  home,  because 
they  knew  that  their  sister  had  had  a  Wassermann  taken  and  felt 
that  sexual  relations  must  have  taken  place  between  her  and  patient.  In- 
formants asked  if  they  would  back  the  loan  for  the  wedding  fee.  Xavier 
stated  that  when  they  made  out  checks  for  this  month's  rent  he  would  put 
in  some  extra  money.  George  said  he  would  too,  but  on  second  thought 
they  both  said  they  thought  it  would  be  better  for  patient  to  understand 
that  he  could  not  get  any  help  from  them  and  both  refused,  stating,  how- 
ever, that  if  visitor  loaned  the  money  and  did  not  get  it  back  they  would 
pay  visitor,  but  did  not  want  their  sister  to  know.  They  feel  if  their  sister 
marries  it  only  means  one  more  for  them  to  care  for.  They  want  the 
marriage  plans  discontinued.  Mrs.  Driscoll's  condition  is  ascertained  and 
brothers  both  agree  that  marriage  is  the  wisest  thing. 
MN/MCW  "         "    - 


5/8  APPENDIX    A 

ACTION  TAKEN 
1918 

Patient  to  report  at  regular  stated  intervals,  at  present  two  weeks 
apart,  for  medical  treatment.     Patient  to  get  lighter  work. 

January  23. 

Eviployer,  Mr.  David  F.  Hyde,  Supt.,  F.  Q.  Craivford  Co.,  telephoned 
to.  Informant  states  that  he  would  interview  patient  in  regard  to  work. 
Patient  sent  with  note  to  Mr.  Hyde.  See  letter  No.  i.  Employer,  Mr. 
Hyde,  telephoned  visitor.  He  stated  that  he  would  employ  patient  pro- 
vided a  recurrent  stroke  was  not  likely  to  occur,  as  they  have  insurance 
for  employees  over  a  limited  period  of  time,  and  he  did  not  wish  to  employ 
men  if  the  risk  was  too  great.  Visitor  had  informant  connected  with 
Dr.  Traiser  by  phone. 

January  23. 

Patient  seen  at  Men's  Club.  He  states  that  he  is  to  begin  work  at  the 
F.  Q.  Crawford  Co.  to-morrow,  salary  $15  a  week. 

January  24. 

Patient's  fiancee,  Mrs.  Driscoll,  taken  by  visitor  to  the  Gynecological 
Clinic  of  the  Boston  Dispensary.  Dr.  Kellogg  examined  her.  Patient  is 
probably  three  months  pregnant,  and  is  to  return  in  one  month.  Mrs. 
Driscoll  wants  to  get  married  quietly.  This  costs  $16,  $11  if  announced 
three  consecutive  weeks  in  the  church.  Application  for  license  made  at 
the  City  Hall.  License  may  be  obtained  on  the  29th. 
MN/S 

January  29. 

Patient  to  clinic.     Seen  by  Dr.  Traiser.     Patient  not  to  return  for  3 
weeks.     Patient  said  that  his  work  was  lighter  than  steamfitting.     Patient 
promised  loan  for  wedding  fee.     Patient  loaned  $0.50.     Patient  stated  that 
"Bess"  had  been  to  Worcester  to  attend  the  funeral  of  her  uncle. 
MN/MCW 

January  30. 

Patient  to  Men's  Club.  Patient  enjoyed  himself  and  talked  a  good 
deal  of  the  time.  The  conversation  was  on  the  war  and  patient  remi- 
nisced on  the  Spanish  war. 

MN/MCW 

January  30. 

Patient's  fiancee,  Mrs.  Driscoll,  visited.  Says  patient  is  to  be  married 
on  the  nth.  Is  much  upset  about  patient's  disregard  for  rnoney.  She 
anticipates  quarrels  on  the  subject  after  they  are  married.  Said  the  $0.50 
visitor  gave  him  on  way  to  work  he  spent,  saving  only. $0.05  and  expected 
her  to  give  him  money  to  go  to  work  on  next  day. 
MN/MCW 

February  5. 

Patient's  fiancee's  brothers  called  on.  They  are  willing  to  help  if  the 
sister  asks  them  to  help,  but  feel  that  patient  should  handle  his  own  afifairs. 

Impression:     Fair-minded  but  disgusted  with  their  sister  and  what  has 
been  going  on  between  her  and  the  patient  for  some  time. 
MN/MCW 

February  6. 

Patient's  fiancee,  Mrs.  Driscoll.  to  hospital.  In  an  upset  condition 
bcrause   patient    had    struck    her    daughter.    Thinks    she    canngt    marry 


APPENDIX    A  579 

1918 

patient  and  that  it  is  best  for  her  to  have  an  abortion.     Feels  that  if 
patient  continues  to  spend  money  as  he  does  now  that  they  will  soon  be 
in  debt  if  they  are  married.     Patient  advised  not  to  marry  if  she  feels 
that  way  and  told  of  agencies  that  can  help  her  if  she  does  not  marry. 
MN/MCW 

February  6. 

Employer,  Mr.  Hyde,  seen.  Employer  stated  that  patient  was  a  good 
worker  and  that  he  would  see  that  he  received  a  raise.  The  raise  would 
be  $0.02  an  hour,  giving  patient  $0.33  an  hour. 

February  8. 

Cooperative  Work  Shop,  Miss  Manson,  telephoned  to.  Promised  to 
consider  the  case  and  have  visitor  get  Mrs.  Driscoll  some  work. 

February  9. 

Visitor  called  on  Mrs.  Driscoll.  Mrs.  Driscoll  stated  that  patient  had 
been  very  kind  to  her  and  her  daughter  and  they  would  be  married  at  eight 
o'clock  on  the  nth. 

February  11. 

Visitor  attends  ivedding  at  St.  Francis'  Church  and  gives  patient  check 
for  $11,  wedding  fee. 
MN/MCW 

February  13. 

Cooperative  Work  Shop,  Miss  Manson,  telephones  that  patient  has 
received  work. 

February  13. 

A  worker  in  training  takes  her  washing  to  patient's  wife. 

February  20. 

Visitor  called.  Patient's  wife  stated  that  her  brothers  had  not  helped 
her  out  on  this  month's  rent,  but  that  she  and  patient  were  saving  so  that 
they  could  pay  it  soon.  Patient's  wife  promises  to  go  to  the  Lying-in 
Hospital  to-morrow. 

March  2. 

Patient's  zmfe  brings  in  Steamfitters'  Union  papers  to  be  filled  out 
by  administrator. 

March  6. 

Papers  filled   out  by  Dr.  Phillips,   stating   patient  treated  here   for 
neurosyphilis  and  under  treatment  since  Jan.  21st. 
MN/MCW 

March  16, 

Wife  in.  Stated  that  patient  is  2nd  in  charge  of  his  room.  That  he 
and  foreman  like  each  other  very  much, 

MN/MCW 

March  25. 

Cooperative  Work  Shop,  Miss  Manson,  telephoned  to.     States  patient's 
wife  has  been  in  3  times  for  work;  does  not  work  well,  but  she  improves 
each  time.     She  has  asked  for  work  for  her  husband's  mother.    Visitor 
stated  what  she  knows  about  patient's  mother. 
MN/MCW 

April  10. 

Patient  in  for  treatment.  Patient  stated  that  he  is  feeling  better  and 
that  family  are  now  living  at  5  York  Terrace,  Chelsea.     Have  5  rooms, 


58o 


APPENDIX    A 


1918 

electric  lights  and  steam  heat,  for  which  they  pay  $20  a  month.  Rent  is 
really  $35  but  they  do  the  janitor's  work  for  the  balance.  Patient  states 
that  he  earns  about  $16.50.  He  could  make  more  money,  but  gets  tired  and 
therefore  does  little  or  no  overtime  work  for  which  he  would  get  1J/2  extra. 
Patient  hopes  soon  to  be  able  to  return  to  steamfitting,  but  promises  not 
to  do  this  until  the  doctor  feels  it  is  the  wisest  and  best  thing  to  do. 
Patient  stated  that  wife  will  not  go  to  the  Lying-in  Hospital.  She  will 
either  go  to   St.   Catherine's   Hospital   or  be   confined  at   home. 

Visitor  has  urged  patient's  wife  to  go  to  the  Lying-in  Hospital,  but 
she  has  many  friends  who  have  been  to  St.  Catherine's  and  she  can  be 
confined  by  a  Catholic  doctor.  Patient's  wife  is  persistent  in  this  in  spite 
of  the  fact  that  Miss  Dean,  Supt.  of  the  Lying-in  Hospital,  says  she  might 
have  a  Catholic  priest  called  in  if  she  so  wished. 

Patient  stated  that  they  had  had  no  help  from  wife's  brothers  and 
that  they  were  not  looking  for  it  and  did  not  want  it.  Said  that  they  v,^ere 
planning  to  visit  them  some  time,  but  that  they  felt  that  since  the  brothers 
owned  autos  they  could  take  the  initiative.  Patient  working  and  improving 
and  shows  no  mental  disorder  and  they  are  both  capable  of  making  their 
own  plans.  Patient  reports  regularly  for  treatment.  $11  to  be  collected. 
MN/MCW 

May  I. 

Patient  in  for  treatment.  Gave  visitor  $1  on  $11  owed  for  wedding 
fee.  Patient  very  much  pleased  with  new  apartment,  but  feels  they  will 
have  to  move  before  another  winter  as  the  boilers  are  not  sufficient  to  give 
enough  heat  to  the  entire  building.  Patient  claims  that  his  wife  has  the 
money.  He  does  not  know  what  she  does  with  it,  but  he  is  constantly 
after  her  to  pay  the  visitor  back.  He  says  she  is  pretty  stingy  and  said 
he  had  to  pay  for  2  treatments  in  order  to  get  the  extra  $1  so  that  we 
could  start  in  paying  visitor.     Will  try  to  bring  more  soon. 

May  10. 

Patient  in.     Paid  balance  of  $11.02. 

May  13. 

Patient's  zvifc  in.  Patient's  wife  delighted  with  new  apartments.  Feels 
now  that  as  soon  as  a  few  more  dishes,  etc.,  are  obtained  she  can  invite  her 
relatives  to  come  and  see  her.  They  have  none  of  them  been  to  see  her 
since  she  was  married.  She  wants  to  have  everything  fixed  up  and  then 
invite  them.  H  they  refuse,  well  and  good;  she  won't  bother  them  any 
more.  She  seems  very  proud  of  the  fact  that  she  has  never  asked  them  for 
money  since  she  was  married.  Informant  is  6  months  pregnant,  but  as  yet 
has  not  felt  any  life.  Has  an  appointment  with  a  private  doctor  who  will 
confine  patient  at  St.  Catherine's.  Will  let  visitor  know  results.  Liformant 
does  not  believe  she  is  pregnant.  Informant  is  anxious  that  husband  ob- 
tain work  in  some  other  department,  as  she  feels  that  working  in  the  base- 
ment is  not  good  for  him.  She  says  that  he  gets  very,  very  tired.  As  yet 
they  have  received  no  money  from  the  Steamfitters'  Union  and  seem  to 
feel  that  now  they  may  not.  Informant  has  some  money  saved  up  toward 
confinement  expenses,  but  promises  to  bring  in  money  for  visitor.  Visitor 
urged  upon  her  the  importance  of  this,  stating  that  she  probably  would 
have  less  money  rather  than  more  later  on. 
MN/MMM 

May  13. 

Patient  to  clinic.  Patient  is  anxious  to  obtain  new  work.  He  feels 
that  dampness  where  he   is  working   does   not  agree   with   him.     Visitor 


APPENDIX    A  581 

1918 

refers  him  to  Mr.  Shackley  of  the  Y.  M.  C.  A.   and  gives  him  notes  to 

Mr.    Young,    Library    Bureau,    and    to    Mr.    Nason,    Simplex    Company, 

Danvers. 

June  I. 

Case  closed:  Patient  has  shown  no  mental  symptoms  and  seems  well 
pleased,  industrious,  and  able  to  obtain  a  new  job  whenever  he  wishes  to. 
His  wife  is  expecting  confinement  soon,  has  money  saved  up  to  see  her 
through,  and  is  insistent  upon  having  a  private  Catholic  doctor  and  refuses 
to  go  to  B.  L.  I.  or  in  fact  to  any  hospital. 

Patient  reports  regularly  for  treatment  and  is  told  to  let  visitor  know 
if  he  gets  into  difficulties. 
MN 


582 


APPENDIX    A 


Case  89 
PSYCHOPATHIC   HOSPITAL 

SOCIAL   SERVICE 
NUMBER  293s 
FILE   NUMBER    1 1 201 

0.  P.  D.  NUMBER  NAME    Joseph  Fangillo  * 

RESIDENCE    28  Central  Ave.,  Arlington 
Correspondent    Mrs.  Theresa  Fangillo 

Sex     M  Age    42  Color 

Civil  condition    M  Place  and   pate  of  birth 

Religion    C  3/4/1876 

Time  in  Boston     Life  Occupation     Bookkeeper 

Previous  addresses    Long  St.,  Mat-     In  Mass.    Life  In  U.  S. 

tapan 

When  known  to  social  service     1/28/19 

When  discharged  from  social  service 

Reason  for  being  known  to  social  service    History 

Report  from  confidential  exchange    No  record 

Name  of  father    Henry  C.  (deceased) 

Address 

Name  of  mother     Nell  Bonelli  (deceased) 

Address 

Name  of  spouse     Theresa  Costelli 

Address     28  Central  Ave.,  Arlington 

Names  and  ages  of  children  or  siblings 


W 
Boston, 


Life 


Children : 
John— 13 
Emma — 4J^ 


Admitted    to    house     I,    1/24/19; 

II,  2/24/19;  III,  4/9/19 
Discharged    1,2/13/19;  11,4/5/19; 

III,  s/8/19 


Siblings : 

Mrs.  Bonelli — about  50 

Theresa — about  45 

Antonio — about  47 

Mrs.  Cavalaro 

Mrs.  Mardini 
Authority     I    Vol.,    II    Vol.,   Ill 

Vol. 
Admitted  to  O.  P.  D. 


Recovered 
Unimproved 


Diagnosis        I.  Manic  Depressive        Condition      I. 
II.  Psychasthenia   De-  II. 

pressed 
III.  Psychasthenia 
Social  symptoms  Date    3/1/19 

Unemployment 
Industrial  decline 
Worry 
Social  diagnosis    Disease  Date    3/1/19 

*  All  names  ttsed  in  this  record  are  fictitious.  In  this  case  an  unusually  detailed 
record  was  kept,  as  it  was  one  of  a  group  of  cases  included  in  a  study  of  the  psy- 
chopathic employee  in   industrv. 


APPENDIX    A  583 


PSYCHOPATHIC  HOSPITAL 

SOCIAL   SERVICE 
CASE   NO.  2935 

FILE  NO.  II20I  NAME    Joseph  Fangillo 


ADDRESSES 
Patient's  telephone: 

Can  be  reached  at  Arlington  2640 

Mrs.  Giordani, 

28  Central  Avenue, 

Arlington,  Mass. 
Family  Physician: 

Dr.  Sullivan 

Arlington  1786 
Patient's  sister: 

Mrs.  Bonelli, 

97  Main  St., 

Boston. 
Patient's  brother: 

Antonio  Fangillo, 

Bradbury,  Vt. 
Patient's  sister: 

Mrs.  Cavalaro 

Hamilton  St., 

Chelsea,  Mass. 
Patient's  cousin:  Place  of  employment: 

Nicholas  Tosi,  60  Manhattan  St., 

930  Hamberg  St.,  Boston,  Mass. 

Dorchester,  Mass. 

Tel.  Dorchester  946-W 
Wife's  sister: 

Mrs.  Jennie  Riley, 

43  How^ley  St., 

Roslindale,  Mass. 
Patient's  wife's  another:  (Can  be  reached  by  telephone  of 

Mrs.  Costelli,  neighbor  in  same  house — Beach 

10  Victoria  St.,  1459-M) 

Boston,  Mass. 
Wife's  sister: 

Bertha  Costelli, 

10  Victoria  St., 

Boston,  Mass. 
Patient's  sister: 

Mrs.  Mardini, 

Cedar  St., 

Cambridge,  Mass. 
Patient's  sister: 

Theresa  Fangillo 

Lives  with  her  sister,  Mrs.  Mardini. 


5^4 


APPENDIX    A 


PSYCHOPATHIC   HOSPITAL 

SOCIAL   SERVICE 
CASE  NO.  2935 

FILE  NO.  II20I  NAME    Joseph  Fangillo 


SUMMARY 

1919 

February  12. 
Social: 

Patient  is  a  man  of  42 — born  in  Boston  of  Italian  parents.  He  com- 
pleted a  3-year  high  school  course  at  15,  and  then  took  a  year  of  advanced 
work  there,  after  which  he  completed  a  business  course  of  6  months. 

He  then  did  various  kinds  of  office  work,  followed  by  bookkeeping. 
He  was  a  bookkeeper  for  the  Stratton  Piano  Company,  Boston,  for  16 
years,  starting  at  low  wages  and  working  up  to  $35  a  week. 

After  being  for  2  months  in  191 1  at  the  Boston  State  Hospital,  he 
spent  2  summers  on  a  small  farm  in  Bradbury,  Mass.,  which  he  has  partial 
use  of  for  ^2^  a  year.  Then  for  a  year  he  was  manager  at  the  Marko 
Cafe.  For  the  past  3  years  he  has  been  one  of  three  partners  in  a  liquor 
concern  which  proved  fairly  successful,  each  member  clearing  $1,000  a  year 
in  addition  to  his  salary.  Patient  withdrew  from  this  work  before  Christ- 
mas, 1918,  and  has  been  without  a  position  since. 

Patient  is  married,  having  a  son,  13,  in  high  school,  and  a  daughter, 
4^,  at  home.  Family  rents  a  4-room  flat  in  Arlington  for  $14  a  month. 
The  rooms  are  on  the  first  floor  and  sunny,  neat,  and  comfortably  fur- 
nished, and  there  is  a  fair-sized  garden. 

Physical: 

Patient's  mother  died  of  spinal  meningitis.  Otherwise  the  family 
history  is  not  of  interest,  except  perhaps  the  fact  that  patient's  brother  had 
a  breakdown  15  years  ago  similar  to  patient's. 

As  a  child  patient  had  typhoid  and  diphtheria,  and  2  accidents.  In 
one  he  was  run  over  and  his  legs  were  in  a  plaster  cast  for  9  months. 
There  are  no  results  now.     In  the  other  his  head  was  hit. 

He  is  of  strong  build  and  is  in  good  physical  condition  at  present.  He 
has  worn  glasses  since  19  years  of  age,  his  eyes  having  troubled  him  more 
than  usual  of  late.  They  have  been  treated  only  by  an  optometrist  who 
says  his  vision  is  low  but  perfect  with  lenses.  The  'Wassermanns  of  his 
blood  and  spinal  fluid  are  negative.  He  admits  gonorrhea  and  soft  chancre 
years  ago  for  which  he  had  treatment. 

Mental: 

Patient  was  a  good  student  at  school.  He  was  graduated  from  a 
3-year  course  at  high  school  at  15,  and  then  took  a  4th  year  there  followed 
by  a  business  course  of  6  months. 


APPENDIX    A  585 

I919 

His  work  at  the  Stratton  Piano  Company  was  responsible  work,  and 
patient  had  the  ability  to  keep  the  position  until  6  years  ago.  He  has 
always  been  inclined  to  worry,  however,  and  about  10  years  ago  developed 
a  sex  phobia,  becoming  afraid  even  to  meet  women  on  the  street.  This 
worried  him  excessively.  He  has  always  been  especially  fond  of  outdoor 
sports  and  of  reading  both  fiction  and  books  on  economics.  His  wife  had 
urged  him  to  mix  more  with  others  although  he  has  not  been  especially 
seclusive. 

In  191 1  he  became  nervous  and  fearful,  and  at  the  advice  of  his  private 
physician  left  work  and  went  voluntarily  to  the  Boston  State  Hospital 
where  he  was  given  a  diagnosis  of  psychasthenia.  While  there  he  had 
hydrotherapeutic  treatment.  After  2  months'  care  there,  he  was  discharged 
and  went  to  work  on  his  farm  oil  and  on  for  2  or  3  years. 

Patient  has  always  been  of  even  disposition,  not  moody,  enjoying  com- 
panj-,  though  being  somewhat  quiet.  He  enjoys  his  home,  children,  and 
reading.  He  is  not  sensitive  or  irritable.  He  has  always  been  inclined 
to  worry. 

Both  patient  and  the  Stratton  Piano  Company  agreed  that  he  was 
unable  to  return  to  them.  Patient  was  unhappy  while  in  the  liquor  busi- 
ness. He  found  the  work  and  the  environment  uncongenial.  After  with- 
drawing from  this  in  December,  1918,  he  became  worried  and  apprehensive 
about  the  future  and  felt  some  former  fears  return.  He  attempted  to  keep 
his  self-control  through  walks  of  10  to  15  miles,  but  was  unsuccessful, 
became  depressed  and  hypochondriacal.  He  came  to  this  hospital  as  a 
voluntary  patient. 


RESULTS 

February  12  to  May  12. 
Social: 

There  has  been  no  income,  but  patient's  wife  says  most  of  the  $500 
saved  remains,  as  she  and  the  children  spend  about  half  of  the  time  living 
with  her  mother,  who  apparently  stands  most  of  the  expense  during  the 
visits.  Her  mother  lives  in  the  East  End,  Boston,  and  is  supported  by  a 
son  and  daughter,  both  single. 

Patient's  wife  tried  work  a  few  nights,  dipping  chocolates  at  $1  for 
3  hours  in  a  candy  factory,  but  was  readily  persuaded  of  the  inadvisability 
of  this.  She  has  devoted  a  large  part  of  her  time  to  visiting  patient  at 
the  hospital  and  taking  him  out  for  walks. 

When  patient  was  last  discharged  from  the  hospital,  she  took  Emma 
and  patient  to  their  little  farm  in  Bradbury,  but  returned  to  her  mother's 
on  his  re-admission  to  the  hospital.  She  has  considerable  understanding 
of  patient's  condition  and,  though  somewhat  worried  about  the  future,  is 
making  a  very  brave  fight  and  is  always  cheerful  in  the  presence  of 
patient. 

Physical: 

Patient  has  continued  well  physically.  His  eyes  have  not  yet  been 
examined  by  an  ophthalmologist. 

Mental: 

Patient  was  discharged  from  the  hospital  2/13/19  much  improved,  and 
visited  his  brother  on  a  farm  in  Bradbury,  Vt.     He  got  along  well  for  a 


586 


APPENDIX    A 


1919 

week,  but  after  an  idle  Sunday  his  fears  returned  and  he  was  readmitted 
to  the  hospital  2/24/19.  He  seemed  worse  after  this  second  admission,  but 
pulled  himself  together  sufficiently  to  try  his  farm  at  Bradbury,  being 
discharged  from  the  hospital  4/5/19.  He  worked  there  outdoors  a  few 
days  when  his  old  sex  phobia  returned,  and  he  was  so  discouraged  about 
this  that  he  returned  to  the  hospital,  readmitted  4/9/19.  All  through  his 
stay  at  the  Psychopathic  he  has  worked  hard  on  the  wards,  pleading  con- 
stantly for  hard  work. 

His  chief  fear  all  spring  has  been  that  prohibition  will  not  be  put  into 
effect,  and  that  therefore  he  has  lost  out  by  giving  up  his  liquor  business. 
Although  he  can  reason  with  himself  that  he  is  fortunate  at  all  events  to 
be  out  of  the  liquor  business,  this  fear  still  possesses  him  so  much  that 
he  dreads  reading  the  newspapers.  In  the  last  few  weeks,  however,  this 
fear  has  decreased  considerably,  and  he  feels  that  he  has  it  pretty  well 
under  control. 

He  is  very  anxious  to  get  well  and  repeatedly  says  he  will  do  anything 
in  his  power  to  do  so.  He  frequently  aslcs  whether  visitor  thinks  he  will 
ever  get  well. 

On  5/8/19  patient  was  discharged  to  the  Middlesex  State  Hospital  as 
a  voluntary  patient,  Dr.  Lawson,  his  examiner,  feeling  that  he  would  do 
much  better  there  with  the  increased  facilities  for  recreation  and  team- 
work outdoors. 

May  12  to  September  30. 
Social: 

Patient  remained  at  Middlesex  until  July  14  when  he  went  to  live  at 
his  camp  in  Bradbury.  His  wife  and  children  preceded  him  there  by  a 
few  weeks,  patient  visiting  them  often  during  his  stay  at  Middlesex. 
Patient's  wife  has  canned  a  quantity  of  vegetables  for  the  winter.  Her 
family  have  been  frequent  visitors  to  the  camp  and  have  brought  them 
food  for  the  family.  Patient  plans  to  move  back  to  Arlington  about 
October  i,  the  rent  having  been  paid  all  along  by  his  wife's  relatives 
who  feel  very  kindly  toward  patient  as  do  his  relatives  also.  Both  patient's 
family  and  his  wife's  family  are  superior  Italian  people  of  ambition  and 
thrift.  Patient's  mother-in-law  has  a  large  household  to  cook  for,  as  her 
single  son  and  daughter,  both  working,  and  a  married  daughter,  son-in-law, 
and  their  two  children  live  with  her,  and  in  addition  the  patient's  wife  and 
children  are  frequent  visitors. 

Patient  is  one  of  six  siblings.  The  oldest,  a  sister  with  whom  patient 
lived  several  years  before  his  marriage,  has  several  grown  children  able 
to  support  the  family  without  her  husband's  assistance,  who  is  now  a  semi- 
invalid.  A  brother  is  on  a  farm  in  Brayton,  Vt.,  and  two  of  his  sisters 
live  together,  one  of  them  married,  the  other  working. 

Patient  has  done  his  own  farm  work  this  summer  as  well  as  hiring 
out  to  neighboring  farmers  frequently.  John  has  begun  his  second  year 
at  high  school  in  Arlington  and  Emma  was  sent  to  school  for  a  few  days, 
but  is  now  kept  home  for  a  week  or  two  until  the  family  canning  is  finished 
at  camp  and  the  family  move  to  Arlington  for  the  winter. 

Physical: 

Patient  is  in  excellent  physical  condition  as  a  result  of  outdoor  work. 

Mental: 

Patient  improved  considerably  at  Middlesex,  doing  six  hours  pick-and- 
shovel  work  there  a  day  most  of  the  time  and  farm  work  at  his  camp 


APPENDIX    A  587 

week-ends.  Early  in  August  efforts  were  made  to  get  him  into  the  employ 
of  the  Gray  Motor  Company,  Dorchester,  in  the  fall,  but  the  employment 
manager  has  found  no  vacancy.  The  Schuleman  Paper  Box  Factory  in 
the  East  End,  which  prides  itself  especially  on  its  humane  handling  of  its 
employees  and  where  another  patient  is  apparently  very  happily  placed, 
stated  early  in  September  they  would  be  glad  to  interview  patient.  As  a 
result,  patient  came  down  from  camp  a  few  days  ago  to  visit  Schuleman's. 
They  agreed  to  take  patient  on  any  time  but  patient  feels  that  though  they 
are  most  considerate  the  chances  for  advancement  are  not  large.  Patient 
says  he  knows  "beggars  can't  be  choosers"  but  says  "I  would  like  some 
place  where  I  could  begin  work  and  work  hard  if  I  felt  that  I  could  learn 
some  useful  trade  or  where  I  could  be  sure  of  advancement  provided  of 
course  I  merited  it."  This  indicates  a  desire  to  plan  for  the  future  which 
he  has  not  manifested  before. 

Patient  reports  that  occasionally  he  has  "fear  spells"  but  much  less 
frequently  and  of  shorter  duration.  He  is  full  of  hope  for  the  future  and 
sure  he  will  be  entirely  well  after  getting  into  new  work.  His  eyes  look 
very  bright  now  instead  of  apathetic. 

September  30  to  December  12. 
Social: 

Early  in  October  patient's  family  moved  to  Arlington  for  the  winter 
but  still  visited  the  farm  frequently  week-ends.  The  children  are  in  school. 
Patient  remained  in  the  country  until  the  end  of  November  picking  apples 
and  coming  to  market  in  Boston  frequently.  The  family  has  on  hand  quite 
a  little  fruit  for  the  winter  and  patient  earned  most  of  the  expenses  of 
the  summer  by  his   farm  work.     His  wife   remains   very  philosophical. 

While  in  the  liquor  business,  $300  was  borrowed  from  patient,  and  a 
brother  owes  him  $700,  and  a  brother-in-law  $200.  He  hopes  to  be  paid 
some  of  this  soon.  He  has  two  $1,000  semi-endowment  life  insurance 
policies.  Patient's  wife  returned  to  candy  dipping  this  fall  at  $1.25  for 
three  hours  in  the  evening,  planning  to  stop  when  patient  is  regularly 
employed. 

Efforts  have  been  made  to  find  patient  suitable  work  through  the 
Y.  M.  C.  A.,  State  Employment  Office,  Bureau  for  Returning  Soldiers  and 
Sailors,  and  Bryant  &  Stratton's.  He  applied  definitely  for  clerical  posi- 
tions at  the  Riverside  Book  Shop  and  at  Schuleman  Paper  Box  Factory, 
Stratton  Piano  Company  have  no  openings  for  patient. 

Physical: 

Patient's  eyes  have  not  been  examined  as  Dr.  Jacobs  advises  no 
examination  for  the  present. 

Mental: 

Dr.  Jacobs  agreed  to  see  patient  because  doing  research  in  psycho- 
neuroses,  and  saw  patient  early  in  October.  He  felt  patient's  diagnosis 
was  between  manic  depressive  depressed  and  psychasthenia  or  a  combina- 
tion of  both,  but  that  patient  was  rapidly  recovering  and  soon  would  be  in 
as  good  shape  as  after  his  attack  several  years  ago.  Every  three  months 
or  so  he  should  report  to  some  psychiatrist  to  make  sure  he  is  not  over- 
working. He  says  there  is  no  reason  why  patient  should  have  to  try  work 
different  from  his  former  clerical  work  but  em.phasizes  the  necessity  of 
patient's  having  a  hobby.  His  fears  are  so  slight  now  that  they  can  be 
disregarded.  Patient  gives  the  credit  of  getting  well  to  his  wife.  He  has 
been  a  little  afraid  of  attempting  bookkeeping  again  but  has  been  per- 
suaded to  do  so. 


588  APPENDIX    A 

The  Riverside  Book  Shop  felt  they  could  not  consider  patient,  as  the 
work  was  especially  nerve-racking,  there  being  only  women  among  the 
customers  and  help  and  books  being  behind.  They  also  felt  that  patient 
must  be  rusty  at  bookkeeping  as  he  had  not  done  any  in  five  years. 

The  Schuleman  Paper  Box  Factory  was  ready  to  consider  patient  for 
clerical  work  but  patient  felt  the  chances  for  advancement  were  not  great 
enough.  When  he  was  finally  convinced  of  the  desirability  of  the  job,  the 
job  was  no  longer  open. 

December  12,  1919,  to  March  12,  1920. 
Social: 

Patient  and  his  family  spent  a  few  days  at  Christmas  with  her  rela- 
tives. The  children  received  about  $35  in  Christmas  gifts  and  patient  $25 
from  his  farmer  friend,  James.  His  brother  has  paid  back  $50  but  no 
other  debts  have  been  paid  him.  His  wife  is  still  working  at  candy 
dipping  at  $1.25  for  three  hours.  The  children  were  sick  at  the  end  of 
January,  John  with  influenza  and  Emma  with  stomach  trouble,  and  patient's 
wife  was  tired  out  at  this  time.  She  still  keeps  up  good  courage.  The 
relations  with  the  landlady  have  been  a  little  strained  but  not  markedly  so. 

Patient  did  not  get  a  job  until  February  11,  when  he  has  since  held  a 
temporary  position  as  bookkeeper  at  $25  a  week.  Many  agencies  assisted 
in  helping  to  look  for  suitable  work  for  patient  but  clerical  openings  for 
men  have  been  exceedingly  scarce,  especially  without  stenography  and  type- 
writing. 

Physical: 

Patient  had  a  slight  cold  but  has  otherwise  been  well. 

Mental: 

Patient  looked  up  many  openings  on  his  own  initiative  as  well  as 
those  suggested  by  agencies  and  visitor.  On  patient's  part  the  following 
were  reasons  for  not  taking  the  jobs  offered:  too  much  responsibility,  and 
not  enough  chance  for  advancement.  He  kept  up  good  courage  although 
admitting  more  and  more  discouragement  at  not  being  able  to  get  a  job. 
He  admits  he  feels  much  better  since  working,  and  feels  sure  he  will  be 
perfectly  well  when  a  permanent  position  presents  itself,  efforts  to  obtain 
which  are  now  being  made. 


HISTORY 

January  29. 

Patient  seen  on  ward. 

Impression :  pleasant,  intelligent,  good  insight  into  condition. 

Patient  says  that  in  his  family  his  brother  had  a  "nervous  breakdown" 
15  years  ago,  which  seemed  similar  to  patient's  present  trouble.  Brother 
was  worried,  broke  down ;  went  "up  country"  where  he  recovered.  Patient 
did  well  at  school,  going  through  High  School  and  finishing  a  commercial 
course  in  6  months.  He  finished  the  two  courses  in  as  short  a  time  as 
possible  because  he  had  little  money.  He  had  his  commercial  training  at 
the  Comer  Commercial  School,  Somerville,  now  out  of  existence. 

Patient  has  worked  as  private  secretary  and  for  16  years  as  book- 
keeper in  the  Stratton  Piano  Company,  a  very  good  position  of  responsi- 
bility and  from  which  he  has  recently  been  given  a  good  recommendation. 


APPENDIX    A  589 

I919 

When  he  went  to  the  Boston  State  Hospital  in  191 1  they  would  not  re- 
employ  him   at   the   Stratton   Piano   Company   on   his    return. 

He  stayed  out  of  work  for  2  or  3  years,  and  for  one  year  was  manager 
of  the  Marko  Cafe,  and  for  3  years  was  in  the  liquor  business  from  which 
he  retired  in  1918.  The  business  was  fairly  successful,  each  of  the  three 
partners  making  $1,000  a  year  besides  their  salary.  Patient  retired  because 
he  disliked  the  business  and  because  he  felt  it  would  be  better  to  get 
started  in  another  position  some  time  before  prohibition  comes  in  July, 

Patient  seems  to  be  happily  married.  His  wife  has  ingenuity  and  a 
happy  disposition.  Of  his  children,  John,  13,  is  in  the  high  school. 
Emma,  4^^,  is  at  home. 

Patient  likes  to  be  among  people,  but  he  is  particularly  fond  of  reading 
both  fiction  and  books  on  economics.  His  wife  has  urged  him  to  mix 
more  with  others  and  he  realizes  that  one  is  better  mentally  when  not 
alone  too  much.  He  is  particularly  fond  of  outdoor  sports,  likes  farming, 
walking,  etc.  He  and  his  wife  go  out  together  occasionally  in  the  evening; 
he  seems  to  have  several  friends. 

Patient  says  he  had  children's  diseases.  At  the  age  of  9  he  was  run 
over  across  his  body  and  in  a  plaster  cast  for  9  months.  He  believes  he 
has  no  serious  results  of  the  accident.  Patient  has  suffered  from  neuritis 
for  some  time.  His  eyes  also  have  troubled  him.  He  has  been  to  several 
doctors  for  treatment,  among  them  being  Dr.  Baker  from  the  Patton 
Building.     He  has  been  under  medical  care  of  Dr.  Francis. 

Patient  says  that  at  the  time  of  his  going  to  the  Boston  State  Hospital 
he  was  run  down  physically  and  nervously.  He  went  voluntarily  and 
seemed  to  improve  under  the  treatment  of  the  baths  he  was  given.  After 
leaving  there  he  could  not  return  to  his  former  position  and  so  for  2  or  3 
years  he  lived  "up  country,"  renting  2  or  3  rooms  and  being  given  all  the 
land  he  wanted  to  farm.  He  improved  here  and  he  seemed  stronger  until 
suddenly  about  2  or  3  weeks  ago  he  felt  a  "fear  spell"  come  on  him ;  things 
worried  him  which  he  was  unable  to  drive  from  his  mind.  He  felt  that 
he  had  made  a  mistake  in  leaving  the  liquor  business ;  that  he  was  not  well, 
etc.  He  realized  that  he  had  to  fight  this  off'  and  for  three  days  he  had 
been  taking  long  walks,  sometimes  for  18  or  20  miles  a  day.  He  suc- 
ceeded in  driving  it  off  but  in  2  days  it  returned  again.  He  could  not  sleep, 
but  felt  he  had  to  be  up  walking  all  the  time ;  but  even  while  walking  he 
could  not  keep  himself  from  worrying.  He  became  discouraged,  intro- 
spective, and  disappointed.  He  went  to  Dr.  Sampson  for  advice,  asking  if 
it  were  not  possible  for  him  to  come  here.  The  doctor  agreed  and  patient 
wanted  to  come  immediately  on  Thursday,  January  25.  The  doctor  per- 
suaded him,  however,  to  wait  until  morning.  He  came  here  voluntarily 
without  telling  his  wife  or  children  where  he  was  going. 

At  present  he  does  not  sleep  well,  but  says  he  is  feeling  stronger  and 
says  he  is  much  better  able  to  control  his  thoughts  and  keep  himself  from 
worrying.  His  main  desire  now  is  to  get  strong  so  that  he  can  be  able 
to  take  a  position,  preferably  not  in  the  bookkeeping  line  because  of  his 
eyes. 

His  wife  said  that  if  he  is  not  better  she  will  break  up  the  home  and 
go  to  live  with  her  mother  or  go  to  work  herself,  but  he  feels  that  he  can 
take  a  good  position  when  the  opportunity  comes. 

January  28. 

Neighbor,  Mrs.  Giordani  (28  Central  Avenue,  Arlington)  telephoned 
to.     Informant  lives  in  flat  above  patient's  family  and  has  known  patient 


590  APPENDIX    A 

several  years.  She  says  that  since  leaving  Boston  State  Hospital  in  191 1 
patient  has  been  "fine"  until  about  6  weeks  ago  when  he  said  that  he  felt 
nervous  and  that  the  "same  trouble  was  coming  on"  again.  He  was  told 
to  mix  in  more  with  others  and  thus  he  would  feel  better.  He  did  this ; 
he  continued  to  be  nervous,  however — he  could  not  keep  quiet  and  seemed 
to  have  to  keep  going  all  the  time.     He  was  a  little  irritable. 

Informant  believes  patient  does  not  drink.  He  has  complained  at 
times  of  his  eyes.  He  has  always  been  quiet — has  always  been  pleasant. 
She  does  not  know  that  patient  has  been  sensitive  or  that  he  has  been 
fearful  of  enemies  or  suspicious  of  friends. 

January  29. 

Present  illness: 

Previous  to  patient's  attack  in  191 1  he  had  been  complaining  of  neu- 
ritis in  his  wrist.  For  this  he  took  medicine.  He  stayed  home  for  a  week 
but  found  even  at  the  end  of  that  time  that  he  could  not  return  to  work. 
He  was  advised  by  Dr.  Francis  to  go  to  Boston  State  Hospital,  where  he 
did  go  voluntarily ;  remaining  two  months.  While  there  he  was  given 
baths,  which  patient  considered  most  satisfactory  treatment.  While  still 
at  hospital  informant  used  to  take  him  out  to  walk  and  would  occasionally 
take  him  home  to  spend  Sunday.  Upon  his  return  home  he  could  not  work 
(even  had  not  his  former  position  been  filled).  Informant  believes  he  was 
run  down  physically  at  the  time.  The  succeeding  summer  he  spent  "up 
country"  on  a  friend's  farm,  where  he  dug  and  worked  outdoors,  and 
where  his  condition  improved.  He  and  informant  spent  the  next  winter 
at  patient's  sister's  home.  The  following  summer  he  spent  again  at  the 
farm  and  in  the  autumn  of  that  year  he  returned  to  work  for  the  first  time 
in  two  or  three  years. 

Informant  feels  that  the  three  years  patient  spent  in  liquor  company 
have  been  a  contributing  factor  in  his  second  attack.  This  business 
brought  him  into  contact  with  a  much  less  desirable  class  of  men  than  he 
had  known  when  a  bookkeeper,  the  environment  about  his  place  of  work 
was  not  pleasant,  and  patient  did  not,  moreover,  like  the  liquor  business. 
For  some  time  he  had  been  considering  withdrawing  from  the  company 
and  finally  did  witlidraw  just  before  Christmas,  1918.  This  business  worry 
has  been  the  only  matter  over  which  patient  need  have  felt  trouble;  he  had 
nothing  at  home  to  cause  him  worry. 

Patient  intended  to  get  into  some  other  form  of  employment,  but  on 
a  night  after  Christmas  a  "spell"  similar  to  one  in  191 1  returned,  which, 
according  to  patient,  was  much  less  severe  than  in  191 1.  After  three  days 
it  wore  away,  for  patient  said  he  was  resolved  to  resist  it  and  fight  it  off. 
In  2  days,  however,  it  returned,  to  wear  away  again.  On  Wednesday, 
January  22,  patient  felt  well  in  daytime  but  was  worse  at  night ;  on 
Thursday  night  he  hardly  slept  at  all  and  he  decided  to  come  here  for  care 
at  this  hospital. 

Informant  denies  hallucinations,  delusions,  or  fears  in  patient.  She 
says  his  mind,  even  at  the  present  time,  has  always  been  clear  and  normal. 
Patient's  nerves  alone  need  some  sort  of  treatment.  Informant  feels  that 
patient  has  improved  while  being  here  and  that  in  two  or  three  weeks  he 
will  be  well  enough  to  return  home. 

February  i. 

Dr.  Lazi'soji,  patient's  examiner  at  hospital,  consulted.  Stated  that 
patient  has  insight.     Informant  has  not  gone  into  his  sex  history,  but  does 


APPENDIX    A  591 

1919 

not  feel  that  the  reasons  for  his  leaving  Stratton  Piano  Company  are  of 
vital  significance  in  his  condition.  Patient's  prognosis  is  good.  Patient 
has  initiative  and  can  himself  state  what  work  is  best  for  him. 

February  3. 

Patient  seen  on  zvard.  Stated  that  a  friend  of  his  has  a  farm  in 
Bradbury,  Mass.  For  the  use  of  a  few  rooms  there  patient  pays  $25  a 
year.  He  has  gone  up  there  several  summers  in  succession.  Patient  has 
between  $500  and  $600  left.  Has  known  his  wife  since  she  was  7  or  8 
years  old.  "Went  with  her"  about  10  years.  For  details  of  patient's  work 
see  "Industrial  History"  enclosed. 

February  4. 

Patient's  wife  seen  at  hospital.  States  that  she  is  of  a  worrying  nature 
— trying  to  look  on  the  bright  side.  Both  her  children  have  stomach 
trouble  from  time  to  time.  Her  family  doctor  is  Dr.  Sullivan  of  Arling- 
ton. Treats  them  from  time  to  time  for  gastritis.  Patient's  wife  often 
takes  the  children  to  her  mother's  for  the  week-end,  opposite  Station  2, 
East  End.  Informant's  father  is  dead  and  her  mother  is  supported  by  a 
son  and  daughter  who  live  with  her. 

February  12. 

Place  of  employment,  Stratton  Piano  Company,  288  Bagley  St.,  Mr. 
Dawson  and  his  father  seen. 

March  15. 

Dr.  Malcolm,  Optometrist,  Rice  Building,  telephoned  to.  Informant 
stated  that  he  has  treated  patient  for  several  years,  the  last  time  being 
December  16,  1918.  At  that  time  his  vision  with  compound  lenses  in  both 
eyes  was  perfect  (20/20)  though  without  lenses  was  15/20  in  each  eye. 
Sees  no  reason  why  patient  could  not  do  any  kind  of  work  he  pleased  as 
far  as  his  eyes  are  concerned.  Stated  that  patient's  lenses  should  be 
changed  about  once  a  year,  though  he  would  like  to  see  patient  soon  as 
he  had  added  a  little  to  patient's  prescription  on  December  16  for  near 
work  and  would  like  to  know  how  this  affected  patient. 

May  24. 

Patient's  mother-in-lazv,  Mrs.  Costelli,  10  Victoria  St.,  Boston,  visited. 
Sister-in-law,  Bertha  Costelli,  also  seen. 

Impression  of  Mrs.  Costelli :  Looks  intelligent,  kindly,  and  healthy, 
but  speaks  almost  no  English. 

Impression  of  Bertha  Costelli :  Intelligent,  warm-hearted,  and  ex- 
ceedingly interested  in  patient  and  his  wife. 

Impression  of  home :  Exceedingly  neat  and  well  furnished,  up  three 
flights.  The  street  is  a  blind  alley  consisting  of  tenements  crowded  closely 
together. 

Mrs.  Costelli  cooks  for  ten  people  including  patient's  wife  and  child. 
Bertha  Costelli  and  her  brother,  both  of  whom  are  single,  and  a  married 
sister  with  her  husband  and  two  children.  Patient's  wife  is  always  afraid  of 
intruding.  Informants  do  not  feel  that  she  is,  however.  Bertha  Costelli 
stating  that  the  Italians  are  more  sympathetic  with  their  friends  in  trouble 
than  other  races. 

Both  patient  and  his  wife  are  splendid  people  and  devoted  to  one 
another.  Informants  see  no  reason  why  patient  should  worry.  Bertha 
regrets  that  her  mother  has  always  worked,  having  started  at  the  age  of  6 
on  a  farm  in  Italy  and  refusing  to  rest  now. 


592  APPENDIX    A 

1919 
May  24. 

Patient's  older  sister,  Mrs.  Bonelli,  gy  Main  St,  visited. 

Impression :  Informant  is  an  intelligent,  refined  Italian,  devoted  to  her 
family  and  to  patient. 

Impresbion  of  home :  Very  neat  and  well  furnished,  on  the  first  floor 
of  a  tenement  house  at  the  better  end  of  Alain  St. 

Patient  has  always  been  studious,  ambitious,  and  conscientious.  Patient 
was  with  informant  4  years  before  his  marriage  15  years  ago.  He  pre- 
ferred being  with  informant  to  living  with  his  mother.  Informant  sees 
patient  and  his  family  often.  At  bookkeeping  he  worked  much  overtime 
and  toward  the  last  wore  2  and  3  pairs  of  glasses  at  a  time.  Informant 
ascribes  his  first  illness  to  overwork.  She  thinks  that  now  he  is  in  better 
physical  condition  than  when  he  broke  down  6  years  ago. 

All  the  relatives  on  both  sides  are  very  sympathetic  with  patient. 
Patient  has  always  made  friends  easily  and  had  many.  Informant  would 
do  her  share  financially  if  help  was  needed,  but  patient's  wife's  family  are 
aiding  at  present. 

Informant  is  the  oldest  child,  followed  by  Antonio  who  has  a  farm 
in  Brayton,  Vt.,  and  has  been  recently  married.  Patient  is  next  followed 
by  a  single  sister  who  lives  with  the  youngest,  Mrs.  Mardini,  Cedar  St., 
Cambridge,  Mass.     Patient  has  not  been  overly  religious. 

Informant's  husband  has  not  worked  in  the  past  2  years.  He  was 
formerly  a  laborer  and  insisted  on  giving  his  children  a  good  education. 
Visitor  saw  one  daughter  who  is  a  High  School  graduate  and  attended 
Bennett's  Business  School. 


January  29. 

Dr.  Francis,  E.  Boston  488-lV,  telephoned  to.  Informant  says  cause 
of  patient's  trouble  is  that  he  went  "sexually  wrong"  about  10  years  ago. 
Informant  would  not  make  more  definite  statement  over  telephone  except 
to  say  that  patient  was  abnormally  sexually  excitable, — if  he  saw  a  female 
approach  on  the  street  he  would  have  to  cut  down  a  side  street,  so  strong 
was  his  sexual  instinct.  He  brooded  and  worried  over  this  until  it  became 
a  mania  with  him  and  this  was  the  sole  cause  of  his  having  to  leave  the 
Stratton  Piano  Company  where  he  had  a  good  position.  He  was  at  the 
Boston  State  Hospital  for  a  short  time  and  has  been  better  in  recent  years. 

Patient  used  to  be  cheerful  and  optimistic  before  marriage.  Infor- 
mant says  his  married  life  has  been  only  fairly  happy,  and  that  recently 
patient  has  had  great  financial  worry.  His  trouble  dates  from  his  mar- 
riage. In  recent  years  patient  has  grown  coarse  and  vulgar,  contrary  to 
his  former  personality.  Informant  feels  that  the  fact  that  patient  had  to 
"rough  it"  while  associated  with  liquor  business  was  a  good  thing  for  him. 

Informant  says  that  patient  has  complained  of  nervous  trouble,  having 
"wandering  pains"  over  body.  Informant  titled  this  "neuritis"  or  "neur- 
asthenia," but  believes  the  pains  were  psychogenic. 

Informant  says  patient  did  not  have  syphilis,  but  that  his  worry  over 
his  sexual  desire  is  cause  of  his  nervous  condition. 


January  29. 

IVife  interviewed  at  hospital. 

Impression :     Pleasant,    intelligent,    self-possessed.     Seems   to  be  co- 
operative, yet  at  times  noncommittal,  perhaps  desiring  to  shield  patient. 


APPENDIX    A  593 

1919 

Family  History: 

Grandparents :  Unknown  to  informant. 

Mother :  Died  at  75  probably  of  pneumonia — bright,  cheerful,  of  ex- 
cellent disposition. 
Siblings : 

1.  Sister,  Mrs.  Bonelli,  97  Main  St.,  Boston. 

About  50  years  old.     Is  well  and  has  several  children. 

2.  Sister,  Theresa,  about  47.     Unmarried. 

Works  in  box  factory.  When  3  or  4  years  old  she  had  spinal 
meningitis,  as  a  result  of  which  she  lost  the  sight  of  one  eye 
and  became  quite  deaf  in  both  ears. 

3.  Brother,    47.      Married.      No    children.      Is    well    and    works    in 

Brayton,  Vt.,  on  a  farm. 

4.  Patient. 

5.  Sister,  Mrs.  Cavalaro,  Hamilton  St.,  Chelsea.  Mass. 

6.  Sister,  Mrs.  Mardini,  Cedar  St.,  Cambridge,  Mass. 

Married.     Well;  good  disposition. 
Informant  knows  of  no  constitutional  disease,  nor  of  any  mental  or 
nervous  trouble  in  family.     Family  is  normal. 

Personal  History: 

Developmental :   Not  known  to  informant. 

Educational : 

Patient  graduated  from  High  School  (which  was  then  composed 
of  3  grades)  at  15.  Being  too  small  to  take  a  position  he  spent 
next  year  in  the  "advanced  course."  He  then  went  to  Comer's 
Commercial  School.  He  seems  to  have  been  noticeably  bright  in 
school. 

Economic : 

Patient's  work  at  Stratton  Piano  Company  satisfactory  to  all  con- 
cerned. 

Marital : 

Married  15  years.  Lived  previously  on  Long  St.,  Mattapan.  Has 
two  children: 

Boy>  13 — ist  year  High  School     ^     Both  children  are  well  and 
Girl,  4j4 — fond  of  dancing  ]        bright  in  intellect. 

Habits : 

Patient  is  not  a  drinker.  He  takes  only  an  occasional  glass  of 
liquor.  Is  only  moderate  smoker.  No  drugs.  Informant  knows 
of  no  infectious  blood  disease. 

Personality : 

Even  disposition,  not  moody.  Is  fond  of  company  and  enjoys 
people.  He  has  friends  in  to  call  and  he  and  informant  go  out 
together  not  infrequently.  Is  quiet,  however ;  likes  to  be  home 
with  his  children  and  likes  constantly  to  read.  Is  not  sensitive  nor 
suspicious.  Is  not  hot-tempered  nor  irritable.  Patient  has  always 
been  rather  inclined  to  worry. 

Medical : 
Informant  knows  of  no  serious  illnesses.     Patient  has  been  at  no 
other  hospital  beside  this  except  Boston  State  Hospital.     He  has 
been  under  care  of  Dr.  Francis  for  several  years.     No  fainting 
attacks. 


594  APPENDIX    A 

ACTION   TAKEN 
1919 
February  i. 

Patient  seen  on  ward.  Anxious  to  remain  another  week  to  get  a  hold 
on  himself.  Thinks  he  will  be  much  better  ofif  after  his  stay  here  and  after 
he  gets  to  work.  Says  he  worries  when  not  working.  Is  anxious  to  do 
any  sort  of  work  whatsoever.  He  had  his  eyes  examined  as  recently  as  a 
few  weeks  ago  by  Dr.  Malcolm  and  had  his  lenses  changed. 

February  3. 

Patient  seen  on  ward.    Will  stay  several  days  longer. 

February  7. 

Neiucomb's  Ink  Co.,  Mr.  Pierce,  employment  manager,  telephoned  to 
regarding  possible  opening  for  patient.  Stated  that  he  had  a  position 
which  would  involve  general  picking  up  about  the  place^  which  might  do 
for  patient.     Asked  that  patient  be  sent  to  him. 

February  8. 

Patient  and  zvife  sent  tvith  note  from  Social  Service  to  Newcomb's  Ink 
Company.  On  his  return  patient  stated  that  Mr.  Pierce  had  not  been 
aware  that  the  position  was  already  filled  by  one  of  the  foremen. 

February  8. 

Netvconib's  Ink  Company,  employment  ma)iagcr  Mr.  Pierce,  telephoned 
that  without  his  knowledge  the  position  had  been  filled  by  a  foreman. 

February  10. 

Patient  seen  on  ward.  Stated  that  he  would  like  to  visit  his  brother 
on  a  farm  in  Brayton,  Vt. 

February  11. 

Newcomb's  Ink  Company,  employment  manager  Mr.  Pierce,  telephoned 
to.  He  has  no  openings  but  will  let  Social  Service  know  if  he  has  a  little 
later. 

February  12. 

Patient  seen  on  zvard.  Stated  that  his  brother  is  to  call  for  him 
2/15/19  and  take  him  to  the  farm  of  this  brother's  fiancee  in  Brayton,  Vt. 
Patient  has  felt  better  since  contemplating  this.  Social  Service  agreed  to 
think  this  plan  over  and  talk  it  over  with  Dr.  Lawson. 

February  12. 

Dr.  Lazvson,  patient's  examiner  at  hospital,  seen.  Thinks  plan  a  good 
idea.  Would  like  to  see  employer,  Mr.  Dawson,  regarding  patient's  sex 
tendencies.     Patient  has  not  spoken  of  this  to  informant. 

February  12. 

Patient's  wife  seen.  Took  patient  out  for  about  two  hours  to-day  as 
she  has  done  for  a  number  of  days. 

February  13. 

Patient  discharged  to-day  from  hospital  as  he  suddenly  decided  he  had 
sufficient  grip  on  himself  to  make  the  plunge  now.  He  will  go  in  a  day 
or  two  to  the  farm  of  his  brother.     Patient's  wife  agreed  to  let  Social 


APPENDIX    A  595 

Service  know  how  patient  gets  along.  After  a  few  weeks  there  patient 
plans  to  return  to  Boston  and  would  like  Social  Service  to  look  for  a  job 
for  patient  in  the  meantime. 

February  25. 

Patient's  wife  telephoned  that  she  visited  patient  2/22/19.  Found  him 
doing  fairly  well  though  he  still  has  "fear  spells"  at  times.  He  is  working 
hard  all  day.  Has  not  yet  planned  on  date  to  return  to  Boston.  Will 
telephone  when  she  has  further  news  of  patient.. 

February  25. 

Patient  was  readmitted  to  hospital  yesterday,  this  fact  not  being  known 
to  Social  Service  or  patient's  wife  at  the  time  of  her  telephone  message. 

February  25. 

Patient's  wife  later  visited  patient.  She  was  somewhat  worried  over 
patient's  apparent  relapse,  but  is  hopeful  of  a  good  recovery,  and  puts 
forward  a  cheerful  face  to  patient. 

February  25. 

Patient  seen  on  ward.  Somewhat  depressed  and  disappointed  that 
work  has  not  cured  him.  Is  determined  to  put  forth  every  effort  to  get 
well,  but  is  doubtful  whether  he  will  recover.  Spent  the  time  in  Vermont 
in  doing  farm  work,  cutting  ice,  hauling  wood,  etc.  On  Sunday  2/23/19 
patient  was  idle  and  had  time  to  worry  considerably,  and  yesterday  he  was 
too  nervous  and  excited  to  work.  His  brother  told  him  he  was  a  "fool" 
to  return  to  the  hospital  and  urged  patient  to  "stick  it  out,"  but  patient  felt 
he  could  not. 

February  25. 

Dr.  Lawson,  examiner  of  patient,  seen.  Stated  that  she  will  go  into 
patient's  sex  history  this  time. 

March  3. 

Dr.  Lawson,  patient's  examiner,  seen.  Patient  is  very  depressed  to-day 
and  is  having  hydrotherapeutic  treatment.  Informant  has  talked  with 
patient  about  sex  matters.  Patient  gives  no  history  of  anything  of  the  sort 
disturbing  him  in  several  years. 

March  7. 

Patient  seen  on  ward — very  depressed  to-day ;  easily  weakening. 
Knows  he  should  not  worry  about  giving  up  the  liquor  business,  but  has 
an  idea  that  prohibition  may  not  be  put  into  effect.  Realizes  fully  that  the 
liquor  business  did  not  agree  with  him.  Also  realizes  that  his  present 
worry  is  inconsistent.  Has  a  fear  of  being  sent  to  the  State  Hospital. 
Reassured  patient  on  this  point.     He  is  "pining"  for  good  hard  work. 

March  7. 

Superintendent  of  Nurses,  Miss  Murray,  seen  and  urged  to  give  pa- 
tient more  work  on  the  wards. 

March  10. 

Patient's  zvife  seen  dt  hospital — looking  more  tired  than  usual.  Stated 
that  for  the  past  week  she  has  been  working  nights  at  a  chocolate  factory 
on  Bar  St.,  dipping  chocolates  at  the  rate  of  $1.00  for  each  night  of  three 


596  APPENDIX    A 

hours,  7  to  10.  She  was  anxious  to  earn  car  fares  in  this  way  and  was 
getting  lonesome  at  home. 

Social  Service  pointed  out  other  sides  to  the  question ;  namely,  that 
patient  would  resent  her  working  now  whether  or  not  he  finds  it  out  until 
later,  and  that  her  children  need  her  at  home,  especially  as  she  visits 
patient  at  the  hospital  daily.  Also  urged  against  it  from  the  point  of  view 
of  her  own  health.  Suggested  that  she  think  the  matter  over.  She  stated 
she  now  felt  she  would  not  return  to  work.  When  asked  the  name  of  the 
firm,  she  would  give  no  further  details  than  to  state  that  only  a  few 
employees  work  there.  Informant  did  not  seem  at  her  ease.  Social  Serv- 
ice made  an  appointment  to  visit  at  her  home  3/12/19  in  the  morning,  and 
she  and  Emma  will  be  at  home.  Emma  is  now  staying  with  wife's  sister, 
Mrs.  Riley,  43  Howley  St.,  Roslindale. 

Later,  when  Social  Service  saw  informant  on  the  ward,  informant 
beckoned  in  uneasy  manner  to  her  to  state  that  she  hoped  Social  Service 
was  not  going  to  visit  the  neighbors.  Social  Service  stated  that  they  haa 
no  intention  of  visiting  neighbors  now. 

March  10.  _ 

Patient's  examiner,  Dr.  IVarren,  consulted.  Stated  that  in  his  esti- 
mation patient  can  do  any  kind  of  work ;  is  strong  physically  and  could 
stand  indoor  work.  Informant  is  willing  for  patient  to  leave  the  hospital 
at  any  time  he  wants  to ;  the  sooner  patient  starts  to  work  the  better.  In- 
formant does  not  know  what  patient's  vision  is  and  says  patient  does  not 
know  what  he  fears  during  his  "fear  spells." 

March  10. 

Patient  talked  with  on  zvard — very  depressed;  still  afraid  he  did  not 
do  the  right  thing  in  leaving  the  liquor  business,  and  that  perhaps  he 
should  not  have  settled  to  the  disadvantage  of  his  partners,  even  though 
they  had  previously  robbed  him.  Does  not  like  to  think  of  leaving  the 
hospital  soon,  as  he  is  afraid  lie  might  attempt  to  make  away  with  himself. 
Assured  patient  that  he  could  not  expect  to  be  entirely  well  until  after 
getting  to  work. 

March  12. 

Home  visited. 

Impression  of  home:  Very  neat,  sunny,  well-furnished  rooms;  four 
in  number  besides  pantry,  on  first  floor  of  a  frame  house.  Situation  on  a 
high  hill  in  Arlington,  five  minutes'  walk  from  Grant  College. 

Patient's  wife  and  Emma  at  home.  Patient's  wife  visited  patient 
yesterday  and  found  him  exceedingly  depressed.  Her  courage  was  good 
until  then,  but  she  has  been  considerably  worried  in  the  last  twenty-four 
hours.  Tears  came  into  her  eyes  easily  during  the  visit.  She  insisted  on 
serving  a  little  luncheon  to  visitor,  which  was  well  prepared  and  nicely 
served. 

Landlady  dropped  in  for  a  few  minutes,  a  very  intelligent,  kind, 
neighborly  person,  evidently  knowing  the  details  of  patient's  illness. 

Emma  obviously  has  adenoids,  and  docs  not  look  exceedingly  well. 
She  seems  bright  but  quite  restless,  a  very  affectionate  and  winning  child. 

Patient's  wife  has  given  up  her  work  at  the  factory.  She  would  hate 
to  have  to  give  up  her  present  home,  but  does  not  see  any  necessity  of  it 
for  several  months  at  least.  The  rent  is  $14.00.  Family  has  lived  in  this 
house  five  years — landlady  occupying  the  second  floor.  Patient's  wife  left 
with  visitor  to  go  to  hospital. 


APPENDIX    A  597 

1919 

March  12. 

Newcomb's  Ink  Co.  visited.  Mr.  Pierce  out.  Was  shown  through 
factory  by  Miss  Martin,  his  office  assistant,  and  by  one  of  the  foremen, 
Mr.  Gordon.  Both  stated  that  they  felt  sure  Mr.  Pierce  would  take 
patient  if  he  could  make  room  for  him,  unless  he  had  some  plan  of  his 
own  to  the  contrary. 

The  factory  is  very  well  lighted  and  roomy,  and  the  atmosphere  is 
kindly.  Miss  Martin  will  let  Social  Service  know  in  case  Mr.  Pierce  can 
fit  patient  in  soon. 

March  12. 

Patient  seen  on  ward.     Seemed  very  cheerful. 

March  14. 

Patient  seen  running  down  the  steps  from  one  floor  to  another  of  the 
hospital.  His  face  was  beaming  and  he  stated  that  he  is  feeling  very  well 
to-day.  His  wife  brought  his  former  partner  in,  with  whom  patient 
settled  one  or  two  matters  on  his  mind.  He  has  been  cleaning  windows 
with  the  attendants  to-day  and  has  spent  a  good  part  of  the  day  doing  this. 
Willingly  agreed  that  work  was  good  for  him. 

March  24. 

Patient's  wife  seen  at  hospital.  Informant  says  patient  was  still  de- 
pressed yesterday  and  does  not  feel  equal  to  getting  out  or  seeing  an 
employer.     Visitor  asked  wife  to  urge  patient  to  go  out  for  a  walk. 

March  25. 

A.  F.  Gainshoro's  employment  manager,  Cambridge,  telephoned  to. 
Informant  stated  that  they  are  not  in  need  of  anything  but  skilled  ma- 
chinists. He  suggested  telephoning  to  the  Federal  Steel  Trades  Cor- 
poration. 

March  25. 

Federal  Steel  Trades  Corporation,  83  Aubiirndale  St.,  employment 
manager  Miss  Fiske  telephoned  to.  Informant  stated  that  openings  have 
been  very  few  and  she  has  no  suggestions  at  unskilled  or  clerical  positions. 

March  25. 

Patient's  examiner,  Dr.  Warren,  telephoned  to.  Informant  stated  that 
he  still  feels  patient  should  soon  return  to  work,  and  that  he  has  stressed 
this  whenever  he  talked  to  patient.  Informant  has  not  talked  much  with 
patient  recently,  but  will  do  so  soon. 

April  5. 

Patient  discharged  to  wife  and  O.  P.  D. 

April  9. 

Patient  admitted  to  house  as  voluntary. 

Aprilio. 

Patienfs  wife  seen  at  hospital.  She  was  disappointed  that  patient  has 
not  been  able  to  hold  his  own  away  from  the  hospital,  but  feels  that  a 
longer  time  here  will  eventually  set  him  on  his  feet. 


598  APPENDIX    A 

1919 
April  II. 

Patient  interviewed  on  ward.  He  is  discouraged  over  the  fact  that  his 
fears  return  as  soon  as  he  leaves  the  hospital.  He  clings  constantly  to  the 
hope  that  his  disease  will  be  cured  eventually.  He  tries  to  keep  his 
thoughts  ofif  of  himself,  and  forces  himself  to  read  the  newspaper,  although 
in  so  doing  he  reads  the  news  concerning  "Prohibition,"  and  concerning 
the  fact  that  the  new  law  may  possibly  not  go  into  effect  after  all.  This 
worries  him,  as  he  feels  remorse  over  the  fact  that  he  may  have  made  a 
mistake  in  retiring  from  the  liquor  business.  He  is  anxious  for  work  and 
for  reading  material. 

April  15. 

Four  current  magazines  sent  up  to  patient. 

April  15. 

Patient's  wife  seen  at  hospital.  She  goes  walking  with  him  every  day 
and  feels  that  he  is  slowly  improving.  She  is  buoyant  and  full  of  encour- 
agement which  patient  seems  to  appreciate. 

April  17. 

Patient's  wife  seen  at  hospital  while  she  was  waiting  to  take  patient 
to  walk.  \i  in  the  near  future  patient  is  considering  leaving  the  hospital 
again,  she  will  let  visitor  know. 

April  21. 

Patient  seen  on  zvard.  He  was  pleased  with  the  magazines.  Said  he 
read  eagerly  every  word  of  them. 

April  22. 

Patient  and  wife  seoi  on  leaving  hospital  for  a  walk  and  told  of  the 
return  of  Miss  May,  former  visitor. 

April  24. 

Patient  and  is.nfc  reported  to  visitor  before  going  out  for  a  walk. 
She  takes  patient  walking  several  hours  a  day  now.  He  says  this  is  the 
only  time  he  enjoys  during  the  day,  as  it  is  the  only  time  he  is  free  from 
fear  spells,  even  when  working  at  the  hospital.  He  still  cleans  windows 
daily. 

April  28. 

Patient  seen  on  zvard.  He  is  much  improved  though  still  fearful  re- 
garding prohibition.  He  reads  the  papers  daily  in  an  effort  to  throw  off 
this  fear.  The  farmer  on  the  land  on  which  patient's  camp  is  located  in 
Bradbury  has  written  urging  patient  and  family  to  move  out.  He  will  get 
the  ground  plowed  and  all  ready  for  patient.  Patient  likes  the  idea  and 
thinks  his  wife  will  go  up  soon  to  see  about  this.  Visitor  urged  that  wife 
do  this  3/30/19  and  that  patient  get  to  work  there  soon. 

April  28. 

Patient's  examiner,  Dr.  Laivson,  consulted.  Informant  stated  that  she 
has  not  talked  with  patient  in  several  days,  but  that  a  week  ago  she  advised 
his  going  to  another  hospital,  such  as  Middlesex,  to  get  into  a  more  suit- 
able atmosphere.  At  such  a  hospital  she  feels  there  is  more  opportunity 
for  exercise,  recreation,  and  work  with  "gangs."  She  does  not  consider 
patient  in  fit  condition  to  work  in  the  community  as  yet.  She  had  hoped 
patient  would  act  on  this  recommendation  himself. 


APPENDIX    A  599 

1919 

May  I. 

Patient  and  his  wife  talked  with  visitor  before  going  out  for  a  walk. 
Dr.  Lawson,  patient's  examiner,  has  advised  his  care  at  Middlesex  and  told 
patient  she  would  see  Dr.  Lang  about  this.  Patient  thinks  it  would  be  a 
good  thing,  as  he  could  do  outdoor  work  under  supervision,  and  he  hopes 
he  will  be  allowed  there  to  frequently  visit  his  country  home,  Bradbury, 
near  by. 

The  farm  patient  visits  consist  of  20  acres  belonging  to  an  Italian 
who  has  a  frame  house  there  divided  up  for  seven  families  which  he  rents 
to  patient  and  others,  all  of  whom  grew  up  together.  Patient  pays  $25 
rent  a  year,  having  the  use  of  2  rooms.  He  can  plow  all  the  land  he  wants. 
Patient  would  consider  also  being  discharged  from  the  Psychopathic  Hos- 
pital and  going  to  Bradbury,  reporting  frequently  to  the  O.  P.  D.  Visitor 
agreed  to  talk  with  the  doctors  about  this.  Patient  says  very  emphatically 
that  he  will  do  anything  in  his  power  to  get  well. 

May  3. 

Patien.  seen  starting  out  for  a  walk  with  his  wife.  He  is  still  hesitant 
about  going  to  Middlesex,  stating  that  he  is  not  sure  they  will  keep  him 
outdoors  sufficiently.  Visitor  told  him  she  would  write  the  Social  Service 
worker  there,  and  that  as  Dr.  Lawson  had  told  him  he  would  work  there 
outdoors  a  great  deal,  there  was  no  ground  for  hesitation.  Patient  agreed 
to  decide  by  5/5/19. 


May  8.  _ 

Patient  and  his  zvife  talked  zvith  in  the  morning.  His  wife  told  him  to 
do  whatever  he  thought  best ;  but  he  has  been  considerably  hesitant.  He 
had  been  advised  by  some  one  to  report  to  the  Middlesex  Clinic  at  the 
Homeopathic  Hospital  5/6/19,  where  he  could  personally  ask  the  super- 
intendent what  the  chances  of  outdoor  work  were.  He  did  not  go  there, 
however,  as  he  decided  to  try  longer  walks  daily,  his  wife  reporting  to  the 
Psychopathic  early  in  the  morning. 

Visitor  assured  patient  that  Dr.  Lawson  did  not  approve  of  his  making 
plans  of  his  own  at  present.  Patient  agreed  that  she  was  right,  and 
decided  to  take  a  trip  to  Middlesex  to-day  with  his  wife  to  ask  the  super- 
intendent about  the  nature  of  his  care  should  he  stay  at  Middlesex. 

Patient's  wife  stated  that  for  a  number  of  weeks  she  and  the  children 
have  been  living  with  her  mother  at  10  Victoria  Street.  Her  expenses 
have  been  light,  consisting  of  rent  in  Arlington  and  occasional  food  at  her 
mother's,  besides  carfares.  She  said  most  of  the  $500  was  still  left  but 
would  not  be  definite. 

Patient  agreed  to  stay  at  Middlesex  if  conditions  seemed  satisfactory. 
Later  he  was  admitted  to  Middlesex  as  a  voluntary  patient. 

May  13. 

Patient's^  wife  telephones  that  she  visited  patient  as  recently  as  5/12/19 
and  found  him  very  contented.  He  has  not  yet  been  put  at  outdoor  work 
but  the  weather  has  not  been  suitable.  Superintendent  said  he  would  have 
to  know  patient  better  to  decide  whether  he  could  let  patient  of¥  for  fre- 
quent visits  to  his  farm  in  Bradbury. 

Patient's  wife  has  received  a  long  blank  to  be  filled  out  regarding 
patient's  mental  history.     Visitor  agreed  to  help  her  in  filling  out  the  blank. 


600  APPENDIX    A 

1919 
May  16. 

Patient's  wife  reported  to  hospital  with  a  blank  to  be  filled  out.  As 
she  is  going  to  Aliddlesex  to-morrow,  visitor  advised  that  she  take  the  blank 
with  her  to  be  filled  out  at  Middlesex.  She  has  taken  the  children  with 
her  this  afternoon  for  a  week-end  in  Bradbury  but  is  returning  to  Boston 
after  that. 

May  23. 

Patient's  wife  telephoned  that  she  found  patient  doing  fairly  well  when 
she  saw  him  5/18/19.  She  is  going  up  to  the  country  again  to-day,  planning 
to  stay  until  the  end  of  next  week.  John  will  continue  to  attend  school, 
living  with  his  grandmother. 

May  24._ 

Patient's  mother-in-laiv,  Mrs.  Costelli,  10  Victoria  St.,  Boston,  visited. 
Informant  invited  visitor  to  supper,  but  visitor  had  already  eaten.  Her 
daughter,  Bertha  Costelli,  says  that  Emma  needs  her  tonsils  removed 
because  she  has  great  difficulty  at  night  in  breathing.  Bertha's  single 
brother  has  just  paid  patient's  rent  in  Arlington  and  Bertha  expects  to  pay 
the  rent  a  little  later,  as  informants  do  not  want  patient  to  give  up  his 
home  yet.  They  are  not  discouraged  about  patient,  although  Mrs.  Costelli 
has  lost  some  weight  worrying  about  him. 

June  2. 

Patient  sent  a  friendly  letter  by  visitor. 

June  19. 

Patient  heard  from.  The  letter  was  written  at  his  camp  in  Bradbury 
where  he  was  spending  Saturday  and  Sunday.  He  says  he  is  much  im- 
proved although  still  bothered  with  those  "fear  spells"  at  times.  He  was 
planning  to  return  to  Middlesex  from  the  camp.  His  stay  at  Middlesex 
is  more  satisfactory  than  at  the  Psychopathic,  as  he  can  work  outdoors 
with  pick  and   shovel  and  keep  busy   with   other  indoor   work. 

Patient's  wife  is  due  in  Boston  on  the  25th  to  attend  John's  graduation 
in  Junior  High  School. 

June  30. 

Patient's  zvifc  reported  to  visitor  at  the  hospital.  A  letter  to  another 
patient  named  Fangillo  had  been  forwarded  from  the  Psychopathic  Hos- 
pital to  patient's  sister  on  Main  Street  for  patient  early  in  June.  Patient's 
sister  had  been  busy  and  neglected  to  forward  the  letter  to  patient.  Patient 
had  just  heard  from  hospital  asking  that  the  letter  be  returned.  Patient's 
wife  came  in  at  once  this  morning  to  straighten  out  the  matter.  She  is 
looking  well  and  says  she  feels  well.  Patient  is  constantly  improving  and 
is  spending  the  week-ends  at  their  camp  in  Bradbury.  He  works  six  hours 
a  day  with  pick  and  shovel  at  Middlesex  and  sleeps  very  well.  He  is  now 
in  the  parole  ward. 

Informant's  relatives  visit  her  at  the  camp  occasionally  and  before 
long  her  mother  as  well  as  her  married  sister  will  stay  for  some  time  at 
the  camp.  Her  relatives  bring  her  food  and  patient  has  planted  quite  a 
few  vegetables  which  will  be  maturing  before  long.  Her  money  is  holding 
out  very  well  and  she  says  she  has  nothing  to  worry  about.  She  has  not 
attended  to  Emma's  tonsils  and  adenoids,  claiming  that  she  has  been  too 
busy.  In  spite  of  visitor's  arguments  to  the  contrary  she  seemed  to  think 
this  matter  should  have  to  be  put  off  until  later  in  the  summer  or  fall. 


APPENDIX    A  60I 

Emma  will  attend  school  in  the  fall.  Informant  agreed  to  keep  visitor 
closely  informed  as  to  patient's  progress.  She  has  jokingly  told  patient 
that  the  next  thing  he  would  worry  about  would  be  his  future  work. 
Patient  told  her  that  he  would  ask  advice  from  the  Psychopathic  Hospital 
when  he  was  ready  to  work  and  that  he  was  sure  work  could  be  found  for 
him  at  which  he  could  keep  well. 

June  26. 

Patient's  wife  heard  from.  Letter  states  that  she  is  too  busy  to  come 
to  town  for  her  son's  graduation  and  states  that  her  husband  is  improving 
though  still  worrying  somewhat. 

July  8. 

Patient  written  to.     Letter  was  sent  to  reassure  patient. 

July  29. 

Patient  heard  from.  Letter  states  that  he  was  discharged  from  the 
hospital  on  the  I4tli  of  July  and  that  he  is  feeling  much  better  though  still 
"very  nervous  and  irritable."  He  is  busy  with  his  garden  and  in  the  past 
two  weeks  has  put  in  thirty  hours'  work  for  the  neighboring  farmers. 
He  expects  to  stay  there  until  November  i,  doing  work  for  the  farmers 
whenever  it  is  available.  He  expects  to  improve  rapidly  now  and  sug- 
gests that  visitor  may  be  able  to  help  him  in  selecting  a  line  of  work  later. 
He  has  not  decided  what  line  of  work  to  take  up  yet.     The  family  are  well. 

August  7. 

Gray  Motor  Company,  Dorciiester,  employment  manager,  Mr.  J.  San- 
born, written  to.  Letter  asks  whether  informant  could  place  patient  in  the 
fall,  stating  that  patient  would  be  willing  to  start  at  any  type  of  work,  but 
would  aim  to  work  toward  clerical  work  or  a  combination  of  clerical  and 
physical  work. 

August  13. 

Patient's  wife  telephoned.  She  came  to  town  to  do  some  errands, 
coming  with  a  friend  by  automobile.  Patient  is  doing  very  well.  He 
sleeps  fairly  well  but  not  yet  perfectly.  He  takes  fishing  trips  and  enjoys 
the  farming.  When  he  left  the  Boston  State  Hospital  the  doctors  warned 
him  not  to  leave  the  country  too  soon.  Informant  plans  to  come  to  Boston 
by  October  i,  probably  starting  Emma  in  for  a  month  of  school  at 
Bradbury.  However,  informant  may  possibly  come  to  Boston  earlier,  if 
patient  is  well  enough  to  come,  spending  the  week-ends  at  the  camp. 

August  13. 

Jackson's  employment  manager,  Mr.  Broivn,  visited.  Informant 
states  that  he  has  but  few  men  on  the  clerical  force  and  that  all  the 
vacancies  are  filled. 

August  18. 

Gray  Motor  Company  telephoned  to.  In  the  absence  of  Mr.  Sanborn, 
chief  ot  the  education  department,  word  was  left  for  him  to  telephone 
visitor  regarding  patient. 

August  21. 

Gray  Motor  Company,  employment  manager,  Mr.  Sanborn,  heard  from. 
Letter  states  that  visitor's  letter  of  August  8  has  been  held  up  pending 


602  APPENDIX    A 

1919 

their  decision  concerning  patient.  At  present,  they  are  completely  filled 
up ;  but  if  a  vacancy  occurs  whereby  they  can  use  him  to  advantage  they 
will  let  visitor  know. 

September  4. 

Patient  zmttcn  to.  Letter  asks  patient  whether  he  is  ready  to  start  in 
at  work  at  any  time  visitor  has  suitable  position. 

September  9. 

Schuleman  Paper  Box  Factory  visited.  Visitor  attended  the  "Shop 
Committee  Meeting"  which  is  held  every  week,  all  the  foremen  and  execu- 
tives being  present  to  discuss  their  needs  and  grievances.  Two  weeks 
before  visitor  had  gone  through  the  factory.  There  are  about  250  em- 
ployees and  the  firm  prides  itself  on  the  fact  that  they  all  feel  like  "one  big 
family."  The  foremen  are  called  by  their  first  names.  Obviously  the 
employees  are  treated  very  considerately  and  they  seem  unusually  happy. 
Mr.  Jones,  superintendent,  stated  he  would  be  glad  to  have  a  talk  with 
patient  and  place  him  to  best  advantage  in  the  factory,  though  he  is  not 
sure  that  the  work  will  lead  to  clerical  work.  Mr.  Chase,  efficiency  expert, 
and  Miss  Macpherson,  nurse,  were  also  talked  to  about  patient.  They  are 
all  interested  in  another  patient  from  the  Psychopathic  Social  Service, 
John  Flynn,  who  has  been  there  two  weeks  and  is  giving  the  greatest 
satisfaction. 

September  10. 

Patient  zvritten  to.  Letter  describes  the  factory  of  Schuleman's  and 
suggests  that  patient  come  to  Boston  soon  to  see  about  an  opening  there 
even  though  he  may  not  be  ready  to  stay  on  in  Boston  as  yet. 

Note: 

The  firm  is  glad  to  take  employees  known  to  reliable  social  agencies 
as  they  consider  that  as  good  as  knowing  their  families.  In  so  far  as 
possible,  they  employ  neighborhood  people  because  the  families  are  acces- 
sible. 

September  11. 

Patient's  wife  telephoned.  She  is  in  town  to-day  and  to-morrow,  start- 
ing Emma  in  at  school.  The  family  expect  to  stay  at  camp  three  weeks 
longer.  Patient  will  answer  visitor's  letter  soon.  He  is  doing  pretty  well. 
Informant  will  telephone  again  to-morrow  as  she  can  hardly  hear  where 
she  is  to-day. 

September  16. 

Letters  to  patient,  addressed  Bradbury,  Mass.,  returned  unclaimed. 
They  were  remailed  to  patient  to  Box  13,  R.  F.  D.,  Bradbury,  Mass, 

September  19. 

Patient  writes  that  he  has  just  heard  from  visitor.  He  will  be  at  the 
hospital  on  September  22  in  the  morning.  He  would  come  in  to-day,  but 
his  potatoes  are  rotting  in  the  ground  and  he  has  about  thirty  bushels  to 
dig  immediately.  John  is  going  to  high  school.  Emma  went  to  school  for 
a  few  days,  but  is  now  at  the  camp  for  about  a  week  until  things  are  in 
shape  for  the  winter. 


APPENDIX   A  603 

1919 
September  22. 

Patient  reported  to  visitor  in  the  morning,  haviirg  jllst  come  down 
from  camp.  He  looked  better  physically  and  decidedly  improved  nerv- 
ously. His  eyes  were  bright  and  he  was  full  of  hope  for  the  future.  He 
occasionally  has  "fear  spells,"  but  he  gets  over  them  rapidly  and  he  thinks 
that  when  he  is  at  work  they  will  vanish  entirely.  He  has  been  doing 
farm  work  for  several  of  the  farmers  in  the  vicinity  as  well  as  at  his  own 
camp.  At  present,  patient's  wife  and  his  mother  are  at  the  camp  putting 
up  tomatoes.  His  son  John  would  rather  live  at  home  in  Arlington  than 
with  his  grandmother.  Yesterday  he  was  out  to  the  camp  and  returned 
last  night  to  stay  in  Arlington.  He  gets  his  own  meals  and  the  landlady 
keeps  an  eye  on  him.  Patient  is  sure  he  gets  into  no  mischief  and  says 
he  is  a  thoroughly  reliable  boy. 

Patient  is  ambitious  to  undertake  work  which  gives  promise  of  ad- 
vancement. Visitor  talked  with  him  about  the  opening  at  Schuleman's 
which  in  many  ways  appealed  to  him.  He  agreed  to  go  down  to  the  plant 
at  once  and  interview  Mr.  Jones,  superintendent.  He  is  planning  to  return 
to  camp  this  afternoon  and  will  let  visitor  know  result  of  his  interview 
either  by  letter  or  telephone. 

September  24. 

Patient  writes  that  he  had  a  nice  talk  at  the  Schuleman  Paper  Box 
Factory  with  Mr.  Jones  and  Mr.  Chase  (efficiency  expert)  and  was  shown 
over  the  factory.  Mr.  Jones  said  patient  could  begin  work  any  time, 
starting  with  at  least  $16.  Patient  has  thought  the  matter  over  carefully 
and  feels  that  though  the  people  there  are  all  very  nice  the  chances  of 
advancement  do  not  look  especially  bright.  He  says,  "I  would  like  some 
place  where  I  could  begin  work  and  work  hard  if  I  felt  that  I  could  learn 
some  useful  trade  or  where  I  could  be  sure  of  advancement,  provided,  of 
course,  I  merited  it."  At  the  factory  apparently  the  most  he  could  aspire 
to  was  to  be  a  "machine  man."  Patient  asked  for  visitor's  advice,  stating 
that  though  he  knows  "beggars  cannot  be  choosers,"  he  does  not  want  to 
make  a  false  start  and  have  to  change  again  in  a  short  time. 

September  24. 

Gray  Motor  Company,  Dorchester,  employment  department,  telephoned 
to.     The  employment  manager,  Mr.  Sanborn,  is  away  for  a  few  days, 

September  27. 

Patient  written  to,  stating  that  visitor  would  give  him  more  definite 
advice  about  his  work  in  two  or  three  days. 

September  29. 

Gray  Motor  Company,  Mr.  Sanborn,  employment  manager,  telephoned 
to.     Informant  states  that  there  is  no  opening  there  for  patient. 

September  30. 

Prospective  employer,  Schuleman  Paper  Box  Factory,  visited.  By  in- 
vitation, visitor  addressed  the  Shop  Committee  Meeting  on  the  subject  of 
mental  hygiene  of  industry,  explaining  her  work  at  the  Psychopathic 
Hospital  in  particular.  The  superintendent,  Mr.  Jones,  stated  that  he 
would  employ  any  patient  visitor  sent  to  him  and  if  there  was  no  opening 
he  would  "make  one."  He  was  interested  in  talking  with  patient  the 
other  day.  Informant  had  in  mind  clerical  work  for  patient  to  advance  to 
and  thinks  patient  could  very  soon  be  placed  at  such  work  there,  as  there  is 


604  APPENDIX    A 

an  opening  now.  It  is  informant's  custom,  however,  to  have  every  office 
employee  advance  from  the  factory  force.  He  did  not  tell  patient  about 
the  prospect  of  clerical  work,  however.  Visitor  agreed  to  let  patient  know 
just  what  the  probable  opportunity  was  and  to  get  in  touch  with  informant 
again.  The  nurse,  Miss  MacPherson,  states  that  should  opportunities,  for 
any  reason,  at  the  factory  seem  limited  to  patient,  there  is  always  a  chance 
of  his  advancing  from  the  paper  box  factory  to  the  Schuleman  Candy 
Factory,  where  there  is  a  large  clerical  force. 

September  30. 

Patient  written-  to,  giving  the  result  of  the  interview  at  Schuleman's 
this  morning  and  stating  that,  though  visitor  did  not  want  to  force  patient 
to  consider  this  opening,  she  felt  the  opportunities  of  advancement  were 
very  good  and  the  atmosphere  there  especially  suited  to  patient.  Her  letter 
explained  the  chances  of  advancement  to  the  Schuleman  Candy  Factory 
from  the  paper  box  factory. 

October  7. 

Patient  zvrites  that  he  has  heard  from  visitor,  but  has  not  yet  come  to 
a  decision.  He  is  very  anxious  to  get  to  work  soon,  saying,  "I  certainly 
feel  the  position  I  am  in  at  present."  Patient  would  come  in  October  6, 
but  he  has  promised  a  farmer  to  pick  apples  until  October  8.  Patient  will 
come  to  see  visitor  October  8. 

October  8. 

Patient  reported  to  visitor  in  the  morning,  bringing  with  him  a  satchel 
full  of  apples  for  visitor  from  the  farm.  His  wife  plans  to  come  to 
Arlington  to  stay  on  October  13,  but  patient  plans  to  follow  her  a  few  days 
later  unless  he  has  a  detinite  jol)  in  town  before  that.  He  is  still  unde- 
cided about  the  kind  of  work  he  should  undertake,  feeling  that  possibly 
indoor  work  will  be  too  confining,  and  that  his  eyes  might  not  permit  of 
confining  work.  He  stated  that  he  would  be  glad  to  see  Dr.  Jacobs  this 
afternoon  for  advice  about  his  work  and  tliat  he  would  be  glad  to  see 
the  employment  manager  at  the  Cole  Rubber  Company  relative  to  possible 
employment  there  later,  visitor  explaining  that  the  employment  department 
is  especially  good  there.  Patient  took  with  him  a  letter  of  introduction 
from  visitor. 

Patient  says  that  when  his  mother  died  she  left  about  $1,000,  of  which 
she  gave  $600  to  patient's  sister  who  is  blind  in  one  eye,  the  other  siblings 
receiving  about  $200  each.  As  a  matter  of  fact,  most  of  them  owed 
patient's  mother  at  that  time  so  that  the  full  amount  of  $200  per  person 
was  not  available.  Patient  loaned  his  share  to  help  out  and  $80  is  still 
due  him  from  this  time  from  a  brother-in-law.  Patient's  brother  Antonio, 
in  Brayton,  Vt.,  wrote  patient's  wife  shortly  after  Antonio's  marriage  this 
summer  about  his  marriage.  Patient's  wife  was  too  busy  to  write  at  that 
time  and  Antonio  has  not  written  patient  since.  Patient  feels  friendly 
toward  all  of  his  relatives,  but  apparently  cited  these  instances  to  explain 
that  often  others  were  more  considerate  of  one  than  one's  own  relatives. 
Patient  feels  especially  grateful  to  his  friend  "Henry"  who  owns  the  farm 
where  patient  has  been  all  summer.  It  is  not  clear  how  much  money 
patient  still  has  on  hand,  but  he  says  that  he  paid  most  of  his  expenses  this 
summer  from  the  work  he  did  on  the  farm.  He  has  on  hand  a  large 
amount  of  fruit   for  the  winter. 

Patient  still  has  occasional  "fears,"  especially  when  not  busy,  but  sa.vy 
they  are  very  mild. 


APPENDIX    A  605 

1919 
October  8. 

Cole  Rubber  Company,  assistant  employment  maitager,  Mr.  Carlton, 
telephoned  to,  who  stated  there  is  only  one  vacancy  in  the  clerical  depart- 
ment now,  which  is  for  a  man  who  is  accustomed  to  figuring  costs.  There 
are  only  three  or  four  laboring  jobs  open,  which  are  all  excessively  heavy. 
Informant  would  be  glad,  however,  to  talk  with  patient  relative  to  future 
employment. 

October  8. 

Patient  reported  to  the  hospital  in  the  afternoon  to  see  Dr.  Jacobs. 
Dr.  Jacobs  states  that  there  really  is  no  "medical  problem"  as  far  as  patient 
is  concerned.  In  other  words,  patient's  diagnosis  is  probably  something 
between  manic  depressive  and  psychasthenia  or  a  combination  of  both,  but 
patient  is  rapidly  recovering.  He  will  soon  be  in  as  good  condition  as 
after  his  attack  of  years  ago.  Every  three  months  or  so  he  should  report 
to  some  psychiatrist  to  make  sure  that  patient  is  not  overworking.  Dr. 
Jacobs  feels  that  there  is  no  reason  why  patient  should  have  to  try  work 
different  from  his  former  clerical  work  and  that  patient  could  now  hold  a 
responsible  clerical  position.  Patient  should  have  a  "hobby,"  as  recreation 
is  quite  essential  for  him.  In  the  past,  when  at  clerical  work,  patient  had 
practically  no  recreation.  Patient's  fears  are  so  slight  now  that  they  can 
practically  be  disregarded. 

October  8. 

Schuleman  Paper  Box  Factory,  Superintendent,  Mr.  Jones,  telephoned 
to,  who  stated  that  there  is  temporarily  no  work  open  for  patient  in  the 
office  as  another  patient  from  the  Psychopathic  Hospital,  Martin  O'Connor, 
is,  for  a  time,  doing  clerical  work  there.  However  informant  feels  that 
before  long  he  will  need  further  help  and  says  that  at  almost  any  time  he 
could  arrange  things  to  take  patient  on.  It  was  mutually  agreed  between 
informant  and  visitor  that  patient  look  around  for  other  openings  and  if 
patient  was  not  successful,  informant  would  make  place  for  him  at 
Schuleman's. 

October  8. 

Patient  reported  to  visitor  that  Mr.  Carlton  at  Cole's  was  very  nice  to 
him  this  morning  but  stated  frankly  that  there  was  no  opening  now  and 
took  patient's  name,  agreeing  to  let  patient  know  should  an  opening  turn 
up.  Patient  had  a  very  satisfactory  interview  with  Dr.  Jacobs.  Patient 
says  he  is  not  as  sure  as  Dr.  Jacobs  that  he  can  go  ahead  and  do  book- 
keeping right  away,  but  as  Dr.  Jacobs  says  he  can,  he  will  try  to  believe  it 
himself.  Visitor  agreed  to  look  into  other  openings  which  would  be  dis- 
tinctly clerical  and  to  let  patient  know  if  a  good  opening  was  found  before 
he  plans  to  return  to  Arlington.  Patient's  wife  has  said  she  would  gladly 
go  to  work  to  supplement  the  income  this  winter,  but  visitor  assured 
patient  this  would  undoubtedly  not  be  necessary.  Patient  left  the  hospital 
considerably  relieved  by  Dr.  Jacobs'  advice. 

October  14. 

Psychopathic  Hospital  Staff,  Dr.  Jacobs,  states  that  patient's  eye  con- 
dition should  not  be  attended  to  now,  as  patient  would  probably  not  like 
any  glasses  ordered  now.  Patient  will  probably  have  another  breakdown 
in  about  five  years. 

October  16. 

Patient's  wife  telephoned  stating  that  she  has  bee'n  in  Arlington  all 
week,  but  goes  to  camp  for  the  week-end  to-morrow.    Patient  will  probably 


6o6  APPENDIX    A 

1919  .  .  .  .        . 

remain  at  the  camp  as  long  as  weather  permits  until  a  definite  openmg  is 
found  for  him.     The  family  are  well. 

October  23. 

Patient  left  some  apples  for  visitor  at  the  hospital  in  her  absence. 

October  30. 

Patient's  zurife  telephoned  that  patient  will  probably  return  from  the 
farm  the  first  of  next  week  to  stay.  As  to-day  is  a  school  holiday  in 
Arlington,  informant  and  the  children  will  go  to  the  camp  for  the  week- 
end. Visitor  stated  that  several  openings  had  been  looked  into  for  patient, 
but  that  visitor  delayed  about  writing  patient  until  the  right  opening  pre- 
sented itself.  Informant  agreed  to  have  patient  get  in  touch  with  visitor 
the  first  of  next  week. 

November  i. 

Federal  Employment  OMce,  4  Cherry  St.,  registrar,  Mr.  Brown,  tele- 
phoned to,  regarding  clerical  openings  for  patient.  Visitor  had  personally 
interviewed  informant  during  the  week  regarding  openings  and  had  tele- 
phoned several  times  since.  There  have  been  no  suitable  openings  for 
patient. 

November  5. 

Patient's  wife  telephoned  that  as  the  weather  has  been  so  pleasant 
patient  will  remain  in  the  country  until  next  week.  Informant  prefers  to 
wait  until  next  spring  about  Emma's  tonsils,  but  agreed  to  speak  to  Emma's 
school  teacher  about  this. 

November  17. 

Patient's  imfe  telephoned  that  patient  is  still  in  the  country  and  will 
remain  there  for  a  few  days  more  unless  visitor  sends  for  him.  He  no 
longer  talks  of  himself,  but  is  planning  for  the  future.  He  is  busy  packing 
and  shipping  apples.  Informant  is  now  housecleaning.  She  seemed 
pleased  to  know  that  the  hospital  feels  she  has  done  a  great  deal  toward 
patient's  recovery  and  assured  visitor  that  her  family  as  well  as  the  hos- 
pital had  done  a  great  deal  also. 

November  17. 

Y.M.C.A.  Employment  OMce,  Mr.  Grafton,  telephoned  to.  Infor- 
mant will  keep  patient  in  mind  for  a  clerical  position.  The  coal  strike  has 
temporarily  pulled  down  business  so  that  openings  are  few.  Informant 
asked  to  have  patient  drop  in  to  see  him  when  next  in  town. 

November  24. 

Federal  Employment  Office,  4  Cherry  St.,  registrar,  Mr.  Brown,  visited, 
who  had  no  suitable  openings  for  patient. 

November  28. 

Patient  reported  to  visitor.  He  came  to  town  to  stay  on  November  26. 
Patient  has  been  busy  bringing  apples  to  town  with  "Henry,"  the  farmer 
at  whose  farm  patient  stays.  They  came  to  market  from  three  to  five 
times  a  week.  Patient  is  now  ready  and  anxious  to  get  to  work,  but  a 
little  fearful  of  clerical  work.  His  face  clouded  somewhat  at  the  mention 
of  clerical  work,  patient  asking  visitor  whether  she  thought  he  could  safely 


APPENDIX    A  607 

1919 

do  clerical  work.  He  is  insistent  that  he  shall  never  have  a  recurrence 
of  his  disease.     Visitor  reminded  him  of  Dr.  Jacobs'  advice  about  his  work. 

His  wife  has  been  working  since  she  came  to  town  this  fall  at  a  candy 
factory  in  the  East  End,  near  her  mother's  home.  She  dips  chocolates 
from  6:4s  to  9:45  P.  M.  daily  at  $1.25  for  three  hours.  She  did  likewise 
in  the  late  spring  before  coming  to  the  camp,  but  did  not  tell  patient  about 
this  imtil  during  the  summer.  Patient  asked  visitor  definitely  not  to  tell 
his  wife  he  had  spoken  of  this.  Visitor  told  patient  that  his  wife  had  told 
visitor  about  her  working  early  in  the  spring  and  that  now  she  would 
doubtless  speak  of  it  when  visitor  called.  Patient's  wife  says  she  would 
miss  work  now  if  she  stopped  as  she  enjoys  the  companionship  of  the 
women  there.  Financially  the  family  is  getting  along  "O.  K."  though 
patient  does  not  know  the  exact  amount  left,  as  his  wife  manages.  He 
plans  to  collect  about  $300  due  him  from  individuals  who  borrowed  from 
him  when  he  was  in  the  liquor  business,  and  he  says  his  brother-in-law 
still  owes  him  about  $200  from  his  mother's  estate,  which  he  will  also  try 
to  collect.  Patient  loaned  his  brother  Antonio  about  $700  several  years 
ago.  At  one  time  patient  paid  Antonio's  board  at  the  rate  of  $7  a  week, 
giving  him  from  $2  to  $3  a  week  besides.  Patient  is  glad  he  laid  in  a 
supply  of  clothes  a  year  ago  considering  the  cost  of  living  now.  He  has 
always  provided  in  advance  when  possible. 

Patient's  wife  and  children  are  not  insured,  but  patient  carries  two 
semi-endowment  policies  under  the  National  Life  Insurance  Company.  In 
case  of  death  a  thousand  dollars  is  due  from  each  of  them,  but  before  that 
time,  if  he  lives  a  number  of  years,  a  few  hundred  dollars  is  payable  in 
addition  to  patient. 

Patient  plans  to  join  either  the  Arlington  or  Boston  Y.  M.  C.  A.  and 
will  look  at  once  into  the  possibilities.  He  is  determined  to  have  exercise 
and  recreation  to  keep  him  well.  Patient  was  given  a  number  of  letters 
of  introduction  to  the  Y.  M.  C.  A.  Employment  Bureau  and  the  State 
Public  Employment  Office,  where  he  expects  to  report  to-morrow  morning. 
Patient  understands  that  clerical  openings  are  scarce  for  men  at  present 
and  is  very  glad  to  have  Mr.  Boylston,  Bureau  for  Returning  Soldiers  and 
Sailors,  keep  him  in  mind  for  suitable  clerical  openings. 

Patient  says  he  is  feeling  better  all  the  time  and  finds  he  is  best  when 
working  hardest.  Only  occasionally  does  he  have  "fears,"  but  he  is  able 
to  control  them. 

November  28. 

F.  M.  C.  A.  Employment  Bureau,  Mr.  Grafton,  telephoned  to.  In- 
formant knows  of  no  clerical  openings  now. 

November  28. 

Federal  Employment  Office,  4  Cherry  St.,  Mr.  Brown,  telephoned  to. 
Informant  knows  of  no  clerical  openings  now. 

November  28. 

Bureau  for  Returning  Soldiers  and  Sailors,  Mr.  Boylston,  telephoned 
to.  Informant  knows  of  no  clerical  openings  for  patient  now,  but  hopes 
to  have  some  soon  and  will  let  visitor  know  when  he  has  a  suitable  opening 
for  patient.  He  does  have  openings  from  time  to  time  into  which  the 
discharged  soldiers  do  not  fit. 

December  i. 

Y.  M.  C.  A.  Employment  Bureau,  Mr.  Grafton,  telephoned  to.  In- 
formant sent  patient  to  apply  on  November  30  at  J.  K.  Hodge's  Hay,  Grain, 


6o8  APPENDIX    A 

1919 

&  Seed  store  in  Chelsea,  where  there  was  a  vacancy  at  office  work  at  $18. 
Patient  has  not  reported  to  informant  since.  Informant  referred  to 
patient  as  a  "nice  chap." 

December  2. 

Patient  telephoned  that  he  had  been  trying  to  reach  visitor  for  the  last 
twenty-four  hours  to  report.  Mr.  Brown,  of  the  Federal  Employment 
Office,  took  patient's  name  and  asked  him  to  report  in  a  few  days.  Mr. 
Grafton  of  the  Y.  M.  C.  A.  took  patient's  name  and  said  he  would  let 
patient  know  when  he  had  a  suitable  opening  for  him.  The  only  openings 
the  Y.  M.  C.  A.  had  were  suitable  really  for  boys.  Patient  agreed  to  report 
to-morrow  again  and  visitor  agreed  to  get  in  touch  with  the  Bureau  for 
Returning  Soldiers  and  Sailors. 

December  3. 

Patient  telephoned,  stating  that  he  plans  to  go  to  the  Federal  Employ- 
ment Office  this  afternoon.  He  is  watching  the  advertisements  in  the 
papers  and  looking  about  somewhat. 

December  3. 

Federal  Employment  Office,  4  Cherry  St.,  Mr.  Brown,  telephoned  to, 
who  knows  of  no  openings  for  patient  to-day.  Patient  reported  to  in- 
formant this  morning  and  will  report  again  to-morrow  morning. 

December  3. 

Jackson  Commercial  School,  Mr.  Ware,  visited,  who  spoke  of  an  open- 
ing at  the  Riverside  Book  Shop.  Miss  Martin  there  is  looking  for  a  first- 
class  bookkeeper  to  straighten  out  the  accounts  now  handled  by  two 
women,  who  together  are  paid  $45  a  week.  Miss  Martin  would  probably 
pay  patient  $30  a  week.  Patient  should  apply  at  once,  stating  that  he 
heard  of  the  opening  through  a  friend.  Informant  could  not  recommend 
patient  as  he  does  not  know  him. 

December  3. 

Patient's  home  visited  as  no  response  was  received  by  telephone. 
Patient  was  home  taking  care  of  Emma  and  George  Giordani.  Patient's 
wife  went  to  the  Arlington  Theatre  to  the  movies,  and  John,  on  returning 
from  school,  did  likewise.  Patient  felt  he  could  not  leave  the  house  until 
his  wife  returned,  and  telephoned  the  Riverside  Book  Shop  to  see  whether 
•  he  ought  to  apply  this  afternoon.  Miss  Martin's  sister  answered  the 
phone,  stating  that  Miss  Martin  was  leaving  for  New  York  to-night. 
Patient  gave  visitor's  name,  which  she  said  she  did  not  know,  and  asked 
patient  to  write  her  his  experience.  Patient's  wife  then  returned  home 
and  went  with  visitor  to  the  street  car.  Visitor  agreed  to  get  in  touch 
with  the  Riverside  Book  Shop  soon. 

December  4. 

Riverside  Book  Shop,  Miss  Martin,  visited.  She  at  once  asked  whether 
patient  had  been  a  patient  at  the  Psychopathic  Hospital  and  then  said  she 
had  troubles  enough  of  her  own  without  employing  someone  from  there. 
Visitor  then  talked  brieily  on  the  subject  of  the  prevalence  of  psychiatric 
conditions  and  need  of  treatment.  Informant  was  then  attentive  and 
agreed  to  look  up  patient's  references,  although,  she  explained,  she  con- 
sidered the  work  "nerve-racking"  as  all  the  customers  were  women  and 
all   of   the   help,   except   one,   were  women   and   the   books   were   behind. 


APPENDIX    A  609 

1919 

Informant  felt  also  inclined  to  think  that  patient  must  be  rusty  in  book- 
keeping if  he  had  done  none  in  five  years.  Informant  is  leaving  for 
New  York  this  morning  and  will  not  be  back  until  next  week. 

December  4. 

Stratton  Piano  Company,  Office  Salesman,  Mr.  Blair,  visited  as  visitor 
was  passing  by.  Mr.  Dawson  was  not  noticed  until  almost  the  end  of  the 
interview  and  visitor  did  not  remember  Mr.  Dawson's  name  so  could  not 
ask  for  him.  Informant  stated  that  patient's  work  was  first-class  and  that 
patient  was  confidential  clerk,  only  one  man  being  over  him.  Patient 
knew  all  that  was  going  on  in  the  office.  Informant  knows  of  no  openings 
in  the  piano  line  now,  but  thinks  patient's  experience  would  serve  him 
equally  well  in  the  lines  of  furniture  or  installment  work.  The  firm  would 
give  patient  an  excellent  recommendation  at  any  time. 

December  4. 

Patient  seen  at  the  Federal  Employment  Office,  4  Cherry  St.,  Mr. 
Brown  had  no  opening  for  patient  then.  Patient  expects  to  join  the 
Y.  M.  C.  A.  as  soon  as  he  is  working.  There  is  a  swimming  tank  there 
but  none  in  the  Arlington  Y.  M.  C.  A.  Patient  is  reporting  to  the  Y.  M. 
C.  A.  Employment  Bureau,  Mr.  Grafton,  this  afternoon,  and  visitor  agreed 
to  look  into  the  openings  at  the  Y.  M.  C.  U. 

December  4. 

Y.  M.  C.  U.  Employment  Bureau,  Mr.  Howland,  visited.  The  bureau 
places  only  non-union  men  and  fills  no  factory  or  laboring  positions. 
Informant  will  be  glad  to  see  what  he  can  do  to  find  a  suitable  position 
for  patient  and  visitor  agreed  to  send  patient  in  to-morrow  morning. 
Informant  states  that  though  clerical  openings  are  not  abundant  they  are 
to  be  had. 

December  4. 

Patient's  home  telephoned  to,  leaving  word  for  patient  to  report  to 
the  Y.  M.  C.  U.  to-morrow  morning. 

December  5. 

Jackson  Commercial  School,  Employment  Office,  Mr.  Ware,  telephoned 
to,  reporting  developments  on  the  Riverside  Book  Shop.  Informant  sug- 
gests getting  in  touch  with  Miss  Martin  early  next  week  again. 

December  5. 

Y.  M.  C.  U.  Employment  Bureau,  Mr.  Hoivland,  telephoned  to,  who 
was  favorably  impressed  by  patient.  Informant  says  he  is  sure  he  can 
find  a  suitable  opening  for  patient  soon.  Patient  is  willing  to  do  selling 
or  clerical  work. 

December  8. 

Riverside  Book  Shop,  Miss  Martin,  telephoned  to.  She  is  sure  that  she 
could  not  take  patient  on. 

December  8. 

Bureau  for  Returning  Soldiers  and  Sailors  telephoned  to.  Mr.  Boyls- 
ton  has  left,  but  his  successor,  Mr.  Max,  suggested  that  patient  might  find 
an  opening  at  Henley  &  Coolidge,  Accounts  Engineers,  350  Rice  Building, 


6lO  APPENDIX    A 

1919 

as  this  firm  has  been  advertising  for  bookkeepers  and  the  bureau  has  sent 
one  or  two  candidates.  Informant  agreed  further  to  keep  patient  in  mind 
for  an  opening. 

December  8. 

Patient's  wife  telephoned  to,  asking  patient  to  telephone  visitor  to- 
morrow morning. 

December  8. 

Patient  written  to,  suggesting  the  opening  at  Henley  &  Coolidge. 

December  9. 

Patient  telephoned  that  none  of  the  agencies  have  found  an  opening 
for  him  yet.  The  Y.  ]\I.  C.  A.  sent  him  to  a  garage  at  Freeman  Square, 
Chelsea,  where  a  bookkeeper  was  needed,  but  they  really  wanted  only  a 
boy  for  a  job. 

December  10. 

Patient  telephoned  to.  He  has  found  no  suitable  openings,  but  expects 
to  through  the  help  of  the  agencies  interested  in  him.  If  he  needs  advice 
during  the  visitor's  absence  until  January  2,  he  will  get  in  touch  with  the 
Social  Service  or  Dr.  Jacobs.  When  visitor  complimented  him  on  his 
success  in  getting  well  he  said  his  wife  deserved  all  the  credit.  Patient 
expects  to  sell  two  pianos  by  Christmas,  netting  him  about  $75. 

December  20. 

Patient  was  mailed  a  Christmas  card. 

1920 
January  2. 

Patient's  wife  telephoned  to.  Patient  is  planning  to  see  visitor  soon. 
Informant,  patient,  and  the  children  were  with  her  family  several  days  at 
Christmas  time.     Patient  has  not  yet  found  work,  but  is  not  discouraged 

January  3. 

Patient  reported  to  visitor,  bringing  a  two-pound  box  of  candy  as  a 
Christmas  gift,  which  his  sister  had  given  him.  She  works  at  Young,  Cobb 
&  Sanborn  and  each  year  gives  patient  candy.  Patient's  wife  is  still  work- 
ing. Patient  has  made  the  rounds  of  the  various  employment  agencies, 
having  added  the  Commercial  Reference  Association  and  the  International 
Reference  Association.  The  only  definite  positions  offered  him  have  been 
through  the  Y.  M.  C.  A.  One  of  these  positions  was  suitable  only  for  a 
young  fellow ;  the  other  is  pending,  a  position  as  ledger  clerk  at  $25  a  week 
at  Hudson  Shoe  Polish  factory  in  Mattapan.  Patient  has  applied  there  and 
telephoned  regarding  the  opening  several  times,  but  each  time  has  been  told 
that  no  decision  has  been  made.  Patient  will  telephone  soon.  The  last 
few  days  patient  has  felt  somewhat  discouraged,  but  has  been  able  to  con- 
tinDl  Eiimself.  He  has  not  sold  the  pianos  as  yet,  as  the  purchasers  find  that 
they  are  twice  as  expensive  as  they  thought. 

The  children  received  a  total  of  about  $35  for  Christmas  from  rela- 
tives and  patient  received  $25  from  his  friend  Henry  on  the  farm.  Patient's 
brother  has  paid  him  $50  of  what  he  owes.  Patient  agreed  to  telephone 
visitor  soon  and  plans  to  continue  consulting  the  employment  agencies. 
Mr.  Brown  of  the  Federal  Employment  Office  has  shown  the  most  interest 
ia  him,  but  he  has  had  no  suitable  openings. 


APPENDIX    A  6ll 


1920 
January  3. 

Jackson  Commercial  School,  Mr.  Ware,  telephoned  to.  Informant 
knows  of  no  openings  for  patient  now,  stating  that  there  are  less  clerical 
openings  for  men  now  than  there  were  last  fall.  Informant  would  be  glad 
to  help  out  at  any  time  he  can. 

January  3. 

Hudson  Brothers,  Mattapan.  telephoned  to.  Employment  Manager, 
Mr.  Beers,  was  out  and  person  answering,  apparently  in  the  superintend- 
ent's office,  would  give  no  information  about  the  firm,  but  suggested  getting 
in  touch  with  Mr.  Beers. 

January  5. 

Patient  telephoned.  He  is  willing  to  have  visitor  use  her  judgment 
about  consulting  Hudson's. 

January  5. 

A  fornvcr  Mattapan  A.  C.  worker  states  that  the  Mattapan  A.  C.  con- 
siders Hudson's  factory  a  very  poor  place  to  work.  The  employees  are 
underpaid  and  the  girls  working  there  are  looked  upon  as  hardly  respect- 
able by  other  working  girls. 

January  7. 

Y.  M.C.  A.  Employment  Bureau,  Mr.  Grafton,  telephoned  to.  In- 
formant states  that  the  outlook  in  the  office  line  is  bad.  It  is  hard  to  fit 
patient  in  other  than  clerical  position  because  he  has  had  no  experience. 
Informant  will  keep  patient  in  mind,  however,  and  try  to  place  him. 

January  7. 

Federal  Employment  Office,  Mr.  Brown,  telephoned  to.  Informant 
offered  patient  two  jobs,  both  of  which  patient  felt  were  too  far  away. 
It  is  not  the  fault  of  either  informant  or  patient  that  former  has  not 
realized  before  that  patient  would  consider  other  than  clerical  work.  He 
will  continue  to  keep  patient  in  mind,  looking  out  for  both  clerical  and 
other  openings. 

January  7. 

Hudson  Brothers,  Manufacturers  of  Shoe  Polish,  Mattat^an,  visited  at 
2  :3o  p.  M.  The  employment  manager,  Mr.  Beers,  was  out.  The  telephone 
girl  asked  whether  visitor  would  see  some  one  else,  but  when  visitor  said 
she  would  see  the  superintendent,  was  informed  that  Mr.  Beers  was  also 
superintendent.  The  advertising  manager  spoke  to  visitor,  but  said  he 
could  do  nothing  about  the  opening  for  patient  as  this  was  up  to  Mr.  Beers. 
Visitor  asked  to  be  shown  over  the  factory,  but  the  advertising  mapagei;- 
stated  that  no  visitors  were  allowed  as  the  process  was,  secret.. 

January  7. 

Bureau  for  Returning  Soldiers-  and  Sailors,  Clerical  Department,  Mr. 
Max,  visited.  Informant  would  be  glad  to  talk  with  patient  and  try  to 
place  him.  He  seemed  more  than  willing  to  advise  visitor  regarding  cler- 
ical openings, 

January  7. 

Patient  telebhoned  to  in  the  evening,  asking  him  to  report  to  Mr.  Max, 
to-morrow  morning.     Patient  had  not  found  any  openings. 


6l2  APPENDIX    A 

1920 
January 

Patient  telephoned  that  he  reported  to  the  Federal  Employment  Office, 
4  Cherry  St.,  this  morning.  Mr.  Brown  told  him  that  though  there  was 
labor  trouble  at  Root's  patient  might  find  an  opening  there.  Patient  ap- 
plied at  Root's  and  the  employment  manager,  Mr.  Fielding,  told  him  to 
come  in  again  the  next  morning.  Patient  asked  visitor's  advice,  but  visitor 
advised  against  the  firm  as  paying  poorly  and  not  giving  much  promise  of 
advancement  for  patient.  Patient  finds  it  difficult  to  go  all  over  town 
looking  for  a  job.  He  has  not  reported  to  Mr.  Max,  but  will  do  so  at 
once.  He  answered  an  advertisement  in  the  Globe  to-day  at  a  team  firm 
as  ledger  and  trial  balance  clerk. 

January  9. 

Patient  telephoned  that  he  reported  to  Mr.  Max  yesterday,  who  was 
ready  to  send  patient  to  the  Loyal  Shoe  Company  but  on  finding  patient 
was  not  an  ex-service  man  felt  he  could  do  nothing  for  patient.  Visitor 
agreed  to  get  in  touch  with  Mr.  Max  again. 

January  9. 

Bureau  for  Returning  Soldiers  and  Sailors,  Mr.  Max,  telephoned  to. 
Informant  did  not  fully  understand  visitor's  work  as  predecessor,  Mr. 
Boylston,  did  not  explain  it  to  him.  In  only  rare  instances  has  informant's 
bureau  placed  men  not  ex-service.  If  patient  is  interested  in  a  job  as  chief 
accountant  at  the  International  Optical  Company,  Lexington,  informant 
would  be  glad  to  get  in  touch  with  the  employment  manager  there,  Mr. 
Bates,  as  informant  has  no  service  man  willing  to  go  out  of  town  to  take 
the  job. 

January  10. 

Patient  telephoned  to,  explaining  the  opening  at  Lexington.  Patient 
agreed  to  talk  it  over  with  his  wife  and  report  later. 

January  10. 

Patient  telephoned  that  he  feels  the  opening  would  be  too  responsible 
at  Lexington  and  he  does  not  care  to  break  down  again.  In  order  to  live 
away  from  his  family  he  feels  he  would  have  to  earn  quite  a  large  salary. 
He  agreed  that  there  is  no  harm  done  in  looking  into  the  opening,  by  cor- 
respondence, at  least,  and  thinks  the  same  opening  is  offered  through  the 
Federal  Employment  Office.  Patient  is  getting  discouraged  about  not  find- 
ing work. 

January  10. 

Federal  Employment  Office,  Mr.  Brown,  telephoned  to.  Informant 
has  no  openings  to-day  except  the  one  at  the  International  Optical  Company, 
Lexington.  Informant  does  not  blame  patient  for  not  being  interested  in 
the  opening  for  the  reasons  patient  gave. 

January  10. 

Y.M.  C.A.  Employment  Office,  Mr.  Grafton,  telephoned  to.  The  only 
opening  this  morning  is  one  as  a  bookkeeper  at  $20  on  St.  Charles  Street. 
Informant  knows  no  further  details  about  it,  but  feels  patient  would  not 
consider  it  as  he  keeps  saying  he  cannot  accept  less  than  $25. 

January  12. 

Jackson  Commercial  School,  Mr.  Ware,  visited.  Informant  states  that 
there  are  no  openings  suitable  for  patient  as  all  of  them  combine  sten- 
ography and  bookkeeping. 


APPENDIX    A  613 

1920 
January  12. 

Women's  Educational  Association,  Appointment  Bureau,  Miss  Black, 
visited  for  possible  suggestions  about  patient.  Informant  suggests  Wood 
&  Berry  Service,  60  Eagle  St. ;  both  Miss  Wood  and  Miss  Berry  were  for- 
merly connected  with  the  U.  S.  Employment  Service. 

January  12. 

Wood  &■  Berry,  60  Eagle  St.,  Miss  Berry,  visited.  Informant  states 
that  clerical  openings  for  men  are  very  scarce,  but  suggested  the  Under- 
wood Motor  Company,  Sawyer  St.,  and  the  City  Gas  Corporation,  as  both 
employing  large  numbers  of  male  clerks.  The  latter  has  taken  on  night 
men  lately  as  business  is  so  heavy. 

January  12. 

City  Gas  Corporation,  North  Street,  Chief  of  Collection  Division, 
Henry  McMillan,  visited.  No  men  are  employed  in  the  clerical  department 
and  there  are  now  no  vacancies  in  the  collection  department,  though  men 
are  working  in  the  collection  department  day  and  night.  Their  pay  begins 
at  $19.50.  _  Informant  would  be  glad  to  put  patient's  name  on  the  waiting 
list  if  patient  cares  to  come  in  to  see  informant.  Suggested  the  book- 
keeping department  on  Victoria  St.  as  a  possibility. 

January  12. 

City  Gas  Corporation,  52  Victoria  St.,  Chief  of  the  Bookkeeping  Divi- 
sion, Mr.  Grant,  visited.  Informant  states  that  there  are  no  openings  now, 
but  he  employs  about  50  men  at  bookkeeping  and  accountancy.  The  firm  is 
apt  to  promote  from  below  but  will  be  glad  to  see  that  patient  is  put  on 
the  mailing  list. 

January  12. 

Patient  visited  at  his  home.  His  son  John  was  at  home  reading  and 
seemed  a  bright,  manly  fellow.  Patient's  wife  was  out.  Patient  feels  that 
the  landlady  has  not  been  quite  as  cordial  to  the  family  since  their  present 
misfortune,  but  admits  that  relations  are  not  very  strained,  as  the  landlady's 
daughter  still  practices  on  patient's  piano  and  patient  feels  free  to  use  land- 
lady's telephone. 

Patient  is  discouraged  at  having  so  much  difficulty  in  finding  work,  but 
realizes  that  many  others  are  in  a  similar  predicament.  He  grits  his  teeth 
in  an  effort  to  drive  away  any  fears  and  has  been  fairly  sucessful.  He 
feels  better  after  talking  with  his  wife  or  visitor.  He  agreed  to  go  to  the 
Cole  Rubber  Company  to-morrow  morning  ready  to  accept  any  kind  of 
work.  He  is  anxious  to  get  to  work  more  to  have  his  mind  occupied  than 
to  get  immediate  income.  Work  out  of  town,  such  as  ice-cutting,  he  would 
find  very  dreary.  He  admitted  the  futility  of  work  such  as  elevator  work, 
hovvever,  as  he  would  be  no  better  off  on  leaving  the  job  than  he  was  on 
beginning  it.  To-day  patient  answered  an  advertisement  in  the  Globe  by 
writing  a  rubber  company  who  wanted  men  to  learn  the  business,  starting 
at  %2'i.  He  applied  at  Reed's,  who  needed  salesmen,  but  said  125  applicants 
applied,  most  of  whom  had  to  be  turned  away.  Patient  was  not  among  the 
first  so  was  not  successful.  He  applied  at  another  place  which  was  adver- 
tised in  the  Globe,  but  on  application  found  that  the  place  had  been  filled 
and  that  about  20  men  had  applied. 

John  cooked  visitor  some  coffee  and  patient  served  some  Italian 
"ravioli,"  and  custard  pie,  all  nicely  cooked. 


6l4  APPENDIX    A 

1920 
January  13. 

Patient  telephoned  that  he  applied  at  the  Cole  Rubber  Company  this 
morning,  but  Mr.  Carlton  there  told  him  that  there  were  no  openings. 
Patient  plans  to  visit  the  City  Gas  Corporation  this  afternoon. 

January  15. 

Schuleman  Paper  Box  Factory,  nurse  Miss  MacPhcrson,  telephoned 
to.  Visitor  explained  that  patient  had  not  considered  an  opening  there  a 
few  months  ago  because  at  the  time  the  opportunities  there  seemed  limited 
to  him.  In  the  meantime  the  patient  has  had  an  opportunity  to  look  about 
considerably  and  he  would  be  interested  to  consider  an  opening  there  now. 
Informant  agreed  to  see  the  superintendent,  Mr.  Jones,  about  this. 

January  15. 

Patient  telephoned  and  was  interested  to  hear  of  a  possible  opening 
at  Schuleman's,  though  he  evidently  still  felt  he  might  have  made  a  mistake 
in  not  making  further  efforts  to  get  a  place  at  Root's,  asking  visitor 
whether  the  Schuleman  opportunity  was  as  good  as  Root's. 

January  16. 

Patient  telephoned  that  he  is  home  this  morning  as  his  wife  has  lum- 
bago. 

January  16. 

Schuleman  Paper  Box  Company,  nurse.  Miss  MacPhcrson,  telephoned 
that  both  she  and  Mr.  Jones  remember  patient  well  and  liked  him  but  that 
there  is  no  opening  this  week.  Possibly  there  will  be  an  opening  next 
week  and  informant  will  let  visitor  know  if  there  is. 

January  17. 

Patient  telephoned — somewhat  discouraged  because  he  has  found  no 
openings.  He  would  like  to  go  to  his  friend  Henry  in  the  country  in 
Bradbury  to  help  him  chop  wood  and  to  consult  him  regarding  openings 
in  automobile  factories  as  Henry  is  in  close  touch  with  some  automobile 
men.  Patient  feels  he  cannot  leave  his  children  alone  at  night  while  his 
wife  is  working. 

January  19. 

Patient  telephoned  that  at  Ring's  Service  Bureau  this  morning  he  was 
told  that  the  John  Meredith  Company  at  Milton  would  take  on  a  number 
of  new  men  for  general  factory  work.  Patient  would  like  to  look  into 
this  opening  and  agreed  to  telephone  an  hour  later  after  visitor  had  got  in 
touch  with  the  firm. 

January  19. 

John  Meredith  Company,  Printing  and  Lithographing  Inks,  factory, 
Milton,  telephoned  to.  Superintendent  Guili,  who  hires  the  factory 
help,  stated  that  he  will  take  on  a  number  of  new  men  if  of  the  right  sort; 
that  is,  having  common  sense  and  with  good  physical  strength.  The  firm 
manufactures  printing  ink  and  the  processes  are  easy  to  learn.  The  pay 
is  52  cents  an  hour  for  a  48-hour  week.  On  certain  processes  after  two 
months  the  pay  is  70  cents  an  hour.  Mr.  Guili  is  not  in  charge  of  the 
office  help  but  connected  visitor  with  Mr.  Mills. 

Mr.  Mills,  Chief  of  the  office  force,  telephoned  to.  Informant  states 
that  he  has  a  number  of  men  in  his  department  earning  varying  salaries 


APPENDIX    A  615 

1920 

depending  on  the  responsibilities.  He  has  no  openings  now,  but  will  be 
glad  to  talk  with  patient  and  keep  him  on  his  list.  Should  patient  want 
to  begin  at  factory  work,  he  would  be  glad  to  try  and  have  him  advance  to 
office  work  when  there  was  an  opening  if  patient  were  suitable.  Visitor 
agreed  to  have  patient  ask  for  Mr.  Mills,  on  arrival  in  Milton  to-day.  Mr. 
Mills  states  that  commuting  would  be  too  hard  on  patient  and  that  it  is 
somewhat  difficult  to  find  a  boarding  place  and  very  difficult  to  find  a  place 
for  a  family. 

January  19. 

Patient  telephoned  and  seemed  interested  in  the  possibilities  at  Milton. 
The  family  have  a  friend  in  Needham  with  whom  either  he  or  the  family 
could  probably  live  if  it  was  hard  to  locate  in  Milton.  Patient  agreed  to 
go  out  to  see  Mr.  Mills  at  once.  Patient  did  not  look  into  the  International 
Optical  Company,  but  frankly  feels  the  work  there  would  have  been  too 
responsible. 

January  20. 

Patient  telephoned  that  he  had  his  usual  luck  at  the  John  Meredith 
Company  yesterday.  At  the  factory  applicants  were  talked  to  in  a  group 
and  told  frankly  that  the  work  was  very  trying  as  they  would  have  to  work 
with  all  kinds  of  acids,  and  with  dyes  which  would  color  the  employee  the 
same  as  the  tint  of  the  dye.  Patient  says  the  smell  was  "awful"  and  that 
he  could  never  stand  it  or  the  change  of  shifts.  The  plant  runs  on  a  three- 
shift  basis  and  patient  would  have  to  vary  in  his  shift  8-4,  or  4-12  or  12-8. 
There  is  only  a  late  afternoon  train  besides  the  i  :45,  so  patient  took  earlier 
train,  though  he  was  unable  thereby  to  see  Mr.  Mills,  who  was  away  for 
luncheon.  Patient  saw  Mr.  Jackson,  assistant  manager  with  the  John 
Rider  Company  yesterday  afternoon.  He  gave  patient  the  name  of  a 
public  accountant  who  might  need  an  assistant.  Mr.  Jackson  is  the  brother 
of  the  man  who  was  in  charge  of  the  business  school  patient  formerly 
attended.     Patient  will  look  up  that  opening  to-day. 

January  20. 

Cole  Rubber  Company,  Employment  Manager,  Mr.  Carlton,  sat  next  to 
visitor  at  a  dinner  of  the  Boston  Employment  Managers'  Association,  and 
stated  that  though  the  factory  needs  female  help  it  has  no  openings  for 
male  help  now.  There  are,  however,  a  number  of  men  doing  clerical  work 
there. 

January  21. 

Schuleman  Paper  Box  Factory,  nurse.  Miss  MacPherson,  telephoned 
to,  who  said  she  plans  to  see  superintendent,  Mr.  Jones,  about  an  opening 
for  patient  this  morning. 

January  21. 

Underwood  Motor  Company,  Sawyer  St.,  Employment  Manager,  Mr. 
Johnson,  telephoned  to.  Informant  says  there  are  no  openings  there  for 
clerks  and  that  he  has  the  problem  of  fitting  three  of  his  present  book- 
keepers into  general  work  as  they  are  putting  in  bookkeeping  machines. 
Informant  volunteered  to  talk  with  patient  about  his  work.  Visitor  agreed 
to  send  patient  to  him. 

January  21. 

Jackson  Commercial  School,  Mr.  Ware,  telephoned  to,  who  stated  that 
the  openings  for  male  clerks  grow  scarcer  and  that  informant  is  solicitous 


6l6  APPENDIX    A 

1920 

about  being  able  to  place  some  of  his  students  who  will  be  ready  in  a  few 

months.     If  patient  has  any  openings  at  all  he  had  better  take  them. 

January  21. 

■Patient  telephoned  that  yesterday  afternoon  he  applied  at  Fletcher  & 
Lothian,  Public  Accountants,  to  whom  Mr.  Jackson  referred  him.  Mr. 
Fletcher  was  out,  but  patient  saw  his  partner,  who  talked  with  patient  and 
asked  whether  patient  was  willing  to  leave  Boston  occasionally  for  six  or 
seven  days  to  make  a  trip  with  the  public  accountants.  Patient  told  him 
he  was  willing  to  travel  and  agreed  to  come  in  on  January  24  to  see  Mr. 
Fletcher.  Patient  plans  to  ask  Mr.  Jackson  to  telephone  Mr.  Fletcher  on 
January  24  regarding  patient's  qualifications. 

January  21. 

Patient  telephoned  that  he  had  a  pleasant  interview  with  Mr.  Johnson 
of  the  Underwood  Motor  Company,  but  there  is  no  opening  there  now. 
Mr.  Johnson  took  patient's  name  and  agreed  to  let  him  know  if  any  suitable 
openings  developed.  Patient  plans  to  visit  Mr.  Jackson  this  afternoon  and 
asked  visitor  what  she  thought  about  his  visiting  the  Gray  factory.  Visitor 
explained  that  the  turnover  was  so  small  at  Gray's  that  there  was  but 
little  chance  of  an  opening,  but  that  if  an  additional  visit  does  not  tire  him 
there  is  no  harm  done  by  applying. 

January  21. 

Y.  M.  C.A.  Employment  Office,  Mr.  Grafton,  telephoned  to.  Al- 
though clerical  openings  are  scarce  for  men,  informant  has  a  few  such 
openings  right  along.  The  only  thing  now  which  would  be  possible  for 
patient  is  as  an  assistant  to  a  public  accountant.  Informant  says  that 
work  is  quite  strenuous  at  times  and  dull  other  times.  Patient  might  find 
work  a  strain  at  the  beginning  of  the  year,  the  busiest  time.  Informant 
has  two  such  openings,  but  has  had  them  some  time  and  does  not  know 
whether  they  have  been  filled.  They  are  :  John  J.  Seavey,  36  Main  St.,  and 
Gerry  &  Co.,  38  East  St.  Each  of  these  pay  from  $5  to  $6  a  day  with  half 
pay  when  laid  off. 

January  22. 

Patient  telephoned  and  agreed  to  look  up  the  positions  as  assistant  to 
public  accountant  at  once.  He  will  then  make  the  usual  rounds  of  the 
employment  offices. 

January  22. 

Schuleman  Paper  Box  Factory,  nurse,  Miss  MacPherson,  telephoned 
that  both  the  superintendent,  Mr.  Jones,  and  she  say  there  are  no  openings 
there  now.  Both  informant  and  Mr.  Jones  are  very  sorry  as  they  remem- 
ber patient  well  most  pleasantly.  Perhaps  in  a  few  weeks  there  would  be 
an  opening.  Mr.  Wells,  employment  manager  at  the  Schuleman  Confec- 
tionery Factory,  is  laying  off  help  at  present. 

January  22. 

Madison  Razor  Company,  Employment  Manager,  Mr.  Mahoney,  tele- 
phoned to.  He  states  that  there  are  no  openings  in  the  plant  for  men  at 
present.  He  says  clerical  openings  are  scarce  for  men,  but  he  does  not 
know  why. 

January  23. 

Patient  telephoned  that  he  applied  to  the  public  accountant,,  Mr.  Bates, 
but  that  there  is  no  opening  there  now.     They  were  nice  to  patient  there. 


APPENDIX    A  617 

1920 

Patient  is  keeping  up  his  courage  pretty  well,  but  his  wife  is  beginning 

to  get  discouraged. 

January  23. 

}'.  M.  C.  U.  Employment  Office,  Mr.  Hou.'land,  visited.  Informant  said 
Stratton  Piano  Company  gave  patient  a  good  recommendation,  but  that  the 
tirm  said  patient's  doctor  had  said  he  could  not  stand  his  former  type  of 
work  again.  Informant  is  willing,  however,  to  abide  by  the  advice  of  the 
Psychopathic  Hospital.  Because  of  patient's  age  and  also  because  of  scar- 
city of  positions  in  general,  informant  has  not  been  able  to  place  patient, 
but  suggested  that  visitor  visit  the  National  Baking  Corporation,  Mr. 
Lowney,  Manager,  who  asked  informant  to  have  a  crippled  soldier  placed 
there.  This  soldier  has  been  doing  very  well.  Informant  suggested  that 
visitor  get  in  direct  touch  herself,  as  Mr.  Lowney  generally  asks  informant 
for  a  "hustler." 

January  23. 

Federal  Employment  Office,  Mr.  Browti.  visited.  He  will  continue  to 
try  to  place  patient,  but  agrees  with  visitor  that  the  best  chance  to  place 
patient  probably  will  be  through  interesting  some  employer  in  him  per- 
sonally, as  otherwise  patient's  age  usually  stands  in  the  way.  Informant 
has  allowed  patient  to  look  over  the  cards  containing  the  requests  from  the 
employers  so  that  patient  will  be  convinced  informant  is  doing  everything 
possible  for  him. 

January  24. 

Patient  telephoned  that  he  did  not  go  around  visiting  the  other  public 
accountant,  but  applied  at  Ring's  Service  Bureau  and  the  Y.  ]\I.  C.  A.,  also 
to  his  friend  Mr.  Jackson  who  will  get  in  touch  with  Mr.  Fletcher  soon. 
Mr.  Jackson  advised  patient  to  send  out  some  form  letters  to  several  public 
accountants  applying  for  positions,  which  patient  will  do  Sunday.  Visitor 
advised  patient  to  get  some  work  shovelling  snow  if  he  was  finding  the 
strain  of  looking  for  a  permanent  position  discouraging  him.  Patient 
seemed  inclined,  however,  to  continue  his  search.  Visitor  asked  whether 
patient  would  be  willing  to  consider  work  in  Lawrence  and  he  said  he 
would. 

January  26. 

General  Anderson  Craig,  Lawrence,  Mass.,  mill  owner,  written  to, 
reminding  him  that  he  offered  to  let  visitor  see  some  of  the  Lawrence  mills 
some  time  and  asking  whether  visitor  could  do  so  within  a  few  days,  stating 
that  she  would  like  to  talk  over  possible  openings  for  patient. 

January  26. 

Patient  telephoned  that  he  had  just  telephoned  his  friend,  Mr.  Jackson, 
who  will  get  in  touch  with  Mr.  Fletcher  about  11  o'clock  this  morning. 
Patient  sent  out  letters  to  six  public  accountants  whose  names  and  ad- 
dresses he  secured  from  the  telephone  book.  He  will  make  the  usual 
rounds  of  employment  agencies  to-day. 

January  26. 

Y.M.C.U.  Employment  Office,  Mr.  Howland,  telephoned  to.  In  his 
absence  word  was  left  that  there  did  not  seem  to  be  any  opening  at  the 
National  Baking  Corporation  for  patient. 

January  27. 

Patient  telephoned  that  he  has  answered  an  advertisement  of  the  Jen- 
kins  Graphophone    Company,    Dalton,    Conn.,    for   general    factory   work. 


6l8  APPENDIX    A 

1920 

The  Federal  Employment  Office  had  an  opening  for  patient  to  consider 
l»ut  it  required  detailed  knowledge  of  the  income  tax,  which  patient  said 
he  has  not  kept  abreast.  He  has  received  three  replies  to  his  letters  to 
public. accountants,  all  stating  that  they  need  no  men. 

January  2y. 

&ene'ral  Atiiers'on  Craig,  mill  owner,  telephoned  that  he  could  arrange- 
for  visitor  to  see  the  mills  any  time  this  week.  He  is  coming  to  Boston 
to-m©rrow  and  will  meet  visitor  at  4 130  to  discuss  the  plans  of  the  next  day. 

Janwary  27. 

■Howland  Business  School,  9  Center  St.,  Employment  Office,  Mr.  Fen- 
ton,  visited.  Visitor  explained  that  one  of  his  former  students  in  her 
employ  had  suggested  that  he  might  be  willing  to  advise  visitor  regarding 
clerical  openings  for  men.  He  stated  that  though  clerical  openings  for 
males  had  been  exceedingly  scarce  for  the  last  six  weeks,  they  have  been 
on  tiie  increase  and  he  feels  that  the  high  water  mark  of  replacing  men  by 
women  has  been  reached  and  that  firms  are  now  putting  on  men  in  place 
of  women.  He  suggested  as  firms  frequently  inquiring  for  help.  Burton 
Tire  Company,  International  Optical  Company,  Gleason  Company,  and 
Lowell,  Johnson  &  Co.,  public  accountants. 

January  28. 

Patient  telephoned  that  there  was  an  advertisement  in  tl  e  Globe  this 
morning  for  a  grocery  warehouse  man  on  East  Street.  From  the  address 
patient  thinks  the  firm  is  Sullivan's.  Patient's  brother-in-law  works  for 
Sullivan's,  so  patient  will  look  into  the  opening  through  him.  Patient 
agreed  to  look  into  some  of  the  openings  that  Howland  Business  School 
had  suggested  and  visitor  agreed  to  write  the  International  Optical  Com- 
pany herself  as  she  knows  Miss  Henderson  in  the  employment  department. 
Patient  said  he  would  be  willing  to  move  to  Lexington  if  the  chances  of 
advancement  were  good  there.  Patient  seemed  interested  in  hearing  about 
visitor's  plan  to  go  to  Lawrence. 

January  28. 

International  Optical  Company,  Employment  Department,  Miss  Hen- 
derson, zvritten  to,  asking  whether  there  would  be  any  opening  for  patient 
there  and  what  the  living  conditions  for  families  are  in  Lexington. 

January  30. 

Patient  telephoned  that  he  was  home  most  of  yesterday  as  John  is  ill, 
having  the  grippe.  He  is  better,  but  Emma  is  sick  to-day.  If  she  does  not 
respond  to  home  treatment,  patient  will  call  in  doctor.  Patient  received 
one  further  reply  from  his  letters  to  accountants  which  stated  that  there 
was  no  question  but  what  patient  was  experienced  but  that  there  were  more 
highly  trained  people  available  for  this  accountant's  purpose.  Patient  will 
try  to  get  in  touch  with  firms  that  visitor  suggested  on  January  28. 

January  31. 

Patient  telephoned  that  he  has  a  slight  cold  but  that  the  children  are 
better.  He  has  received  a  reply  from  Dalton,  Conn.,  stating  that  they 
cannot  place  him  anywhere.  At  this  point  patient  said  he  certainly  had 
"bad  luck"  and  "everything  seems  to  go  hard."  Last  night  he  came  home 
and  told  his  wife  he  at  last  was  sure  he  had  a  job.  Yesterday  Mr.  Brown 
of  the  Federal  Employment  Office  put  him  in  touch  with  an  opening  as  a 


APPENDIX    A  619 

1920 

bookkeeper  for  the  Dean  Blacking  &  Staining  Company  at  $25  a  week. 
This  morning  patient  telephoned  the  firm  and  was  told  that  they  had 
settled  everything  with  their  present  bookkeeper  so  that  a  new  one  was  not 
needed.  Patient  is  afraid  his  age  was  against  him  and  that  the  explana- 
tion given  is  not  the  real  one.  He  promised  to  rest  up  this  week-end  from 
his  cold^ 

January  31. 

Federal  Employment  OMce,  Mr.  Brown,  telephoned  to,  who  agreed  to 
let  visitor  know  later  what  the  real  situation  at  Dean's  was. 

February  2. 

Patient  telephoned  that  Mr.  Fletcher  has  not  yet  returned  from  Provi- 
dence. Patient's  family  are  feeling  better.  They  called  in  their  doctor  for 
Emma,  whose  stomach  was  affected,  though  she  did  not  have  influenza. 
Patient's  wife  has  a  slight  cold  and  patient  is  still  about  the  same.  He 
plans  to  stay  home  to-day.  He  is  answering  two  advertisements  in  yester- 
day's Globe. 

February  2. 

Y.  M.  C.  A.  Employment  Bureau,  Mr.  Grafton,  telephoned  to.  In- 
formant states  that  patient's  "appearance  and  name  queer  him."  Informant 
has  sent  him  out  on  at  least  a  half  dozen  openings  and  though  they  did  not 
take  on  patient  they  did,  however,  take  on  some  one  else.  He  cited  Hud- 
son's as  an  example. 

February  2. 

Y.M.C.A.  secretary,  Mr.  Doyle,  telephoned  to,  who  knows  of  a  tem- 
porary position  for  a  man  to  do  chiefly  bookkeeping  at  Union  Square, 
Chelsea.  He  will  telephone  to  get  the  present  situation  there  and  report 
later  to  visitor.  He  volunteered  that  for  some  unknown  reason  it  is  harder 
for  a  man  out  of  a  job  to  get  a  job  than  for  a  man  who  has  a  job  to  get 
another  one. 

February  2. 

Y.M.C.A.  secretary,  Mr.  Doyle,  telephoned  that  he  has  just  got  in 
touch  with  the  Lambert  Real  Estate  &  Insurance  Company,  Chelsea,  and 
finds  that  the  position  is  still  vacant.  About  three  weeks  ago  the  firm 
asked  informant  to  find  a  man  to  hold  the  position  for  a  few  weeks. 
Informant  sent  a  man  who  filled  the  position  very  satisfactorily,  but  has 
just  left  for  a  permanent  position.  Although  this  work  is  nominally  tem- 
porary, the  firm  is  a  large  and  growing  one,  and  if  patient  fits  in  well, 
informant  thinks  there  might  be  permanent  work  there.  At  all  events,  if 
patient  takes  the  position  he  could  make  it  clear  that  he  might  have  to 
leave  at  any  time  for  permanent  work.  Informant  could  reach  neither 
Mr.  Lambert  nor  Mr.  Hudson,  but  left  word  at  the  office  about  patient. 
Visitor  agreed  to  send  patient  in  to  the  firm  to-morrow  to  apply  for  the 
position. 

February  2. 

Patient  telephoned  to,  telling  him  of  the  opening  at  the  Lambert  Real 
Estate  &  Insurance  Company.     He  agreed  to  apply  first  thing  to-morrow. 

'February  3. 

Patient  telephoned  that  he  applied  at  Lambert's,  but  Mr.  Lambert  said 
a  young  man  was  to  apply  in  a  day  or  so  whom  he  would  like  to  interview 


620  APPENDIX    A 

1920 

before  deciding  anything.  .  It  will  take  two  or  three  days  before  Mr.  Lam- 
bert decides. 

February  3. 

Y.  M.C.A.,  Mr.  Doyle,  telephoned  to,  who  says  that  on  the  face  of  it 
it  looks  as  if  Mr.  Lambert  was  not  favorably  impressed  by  patient.  In- 
formant will  ask  a  man  under  whom  patient  would  work  directly  at  Lam- 
bert's details  about  the  situation  at  Lambert's,  as  this  man  lives  at  the 
Y.M.C.A. 

February  4. 

Patient  telephoned  that  he  will  make  the  usual  rounds  to-day.  He 
heard  from  Mr.  Jackson  that  Mr.  Fletcher  does  not  need  any  men  now. 

February  4. 

Johnston-Abbott  Mills,  Chief  Inspector,  Mr.  Fabian  (visitor's  brother- 
in-law)  written  to,  asking  him  for  advice  as  to  possible  openings  in  Law- 
rence for  patient. 

February  4. 

Boston  University,  Vocational  Department,  Mr.  Warren  seen  by 
chance  in  the  evening.  He  came  over  to  visitor  and  asked  whether  patient 
had  a  job  as  yet.  He  suggested  that  it  would  be  a  good  plan  for  patient 
to  report  to  him  so  that  informant  could  have  him  definitely  on  the  waiting 
list  for  an  opening. 

February  5. 

International  Optical  Co.,  Lexington,  heard  from.  Letter  stated  that 
at  present  the  only  clerical  openings  for  patient  would  be  in  the  Traffic 
Department  at  $20  and  a  probable  one  in  the  Shipping  Department  at 
$18,  both  of  which  informant  thinks  wcnild  not  attract  a  man  of  patient's 
experience.  If  he  is  an  Italian,  that  miglit  liar  Iiim  from  office  positions 
other  than  in  workshops.  An  application  blank  was  enclosed  and  infor- 
mant states  that  possibly  a  better  opening  in  the  offices  may  later  occur,  of 
which  visitor  will  be  advised. 

February  5. 

Patient  written  to,  asking  him  to  report  to  Boston  University,  Mr. 
Warren,  and  telling  him  of  the  reply  from  Lexington.  Patient  has  sent  the 
application  blank  and  visitor  stated  that  she  was  writing  to  the  Interna- 
tional Optical  Company  telling  them  that  doubtless  patient  would  consider 
an  opening  such  as  the  one  in  the  Traffic  Department  if  promised  definite 
advancement. 

February  5. 

biternational  Optical  Company,  Lexington,  Miss  Henderson  written  to, 
stating  that  patient  would  be  glad  to  make  the  trip  to  Lexington  if  there 
should  be  a  good  opening  or  if  the  opening  in  the  Traffic  Department  gave 
promise  of  advancement.  The  letter  asked  that  patient  be  kept  on  the 
waiting  list. 

February  6. 

Patient  telephoned.  He  has  not  received  visitor's  letter.  He  will  go 
to  Boston  University  to-day  and  to  Wood  &  Berry,  which  he  did  not  get 
around  to  as  yet.  His  wife  is  feeling  the  strain  of  the  children's  illness. 
F.mma  is  not  vet  un  and  around. 


APPENDIX    A  621 

1920 
February  6. 

y.  M.  C.  A.  Secretary,  Mr.  Doyle,  telephoned  to,  who.  forgot  to  inquire 
about  the  Chelsea  opening  but  will  telephone  Mr.  Lambert  and  report  to 
visitor  later. 

February  7. 

Patient  telephoned.  He  went  to  see  Mr.  Warren  at  Boston  University 
yesterday  and  had  a  long  talk  with  him.  Mr.  Warren  advised  him  to  apply 
at  the  Harvard  Coal  Company,  Mr.  Marsh,  regarding  an  opening  there  as 
a  bookkeeper.  Patient  applied,  but  Mr.  Marsh  was  not  there  all  day,  but 
to-day  patient  found  him  in.  Mr.  Marsh  was  at  first  very  enthusiastic  and 
thought  patient  could  do  the  work,  but  later  on,  finding  patient  could  not 
do  typewriting,  said  he  would  have  to  interview  three  or  four  others  first, 

February  7. 

Boston  University,  Mr.  Warren,  seen  at  Mr.  Jenkins'  class  for  employ- 
ment managers,  Boston  University.  He  told  visitor  that  there  was  a 
strong  probability  that  one  of  the  professors  at  the  University  would  take 
patient  on  for  temporary  work  and  that  informant  would  get  in  touch  with 
patient  about  this  on  February  9. 

February  9. 

Patient  telephoned  and  was  advised  to  get  in  touch  with  Mr.  Warren, 
Boston  University,  at  once  regarding  the  possible  temporary  opening. 

February  9. 

Y.  M.  C.  A.  secretary,  Mr.  Doyle,  telephoned  that  he  has  got  in  touch 
with  Mr.  Lambert  of  the  Lambert  Real  Estate  Company,  who  says  he  has 
not  interviewed  patient  and  could  not  find  out  who  has.  The  opening  is 
still  there  and  Mr.  Lambert  would  be  glad  to  consider  patient  if  he  can 
do  the  work. 

February  9. 

Boston  University,  Mr.  Warren,  telephoned  to,  who  states  that  the 
temporary  opening  at  Boston  University  has  been  taken  by  a  "young  fellow 
just  out  of  high  school."  Informant  would  be  perfectly  willing  to  have 
patient  consider  the  opening  in  Chelsea. 

February  9. 

Patient  written  to,  asking  him  to  apply  at  Lambert's  and  telling  him 
that  the  opening  at  Boston  University  had  been  filled. 

February  9. 

Patient  telephoned  to  in  the  evening,  asking  him  to  get  in  touch  with 
Mr.  Lambert  to-morrow  morning. 

February  10. 

Patient  telephoned  that  he  interviewed  Mr.  Lambert  this  morning  and 
is  to  begin  work  there  to-morrow  morning.  Mr.  Lambert  asked  patient 
very  few  personal  questions  and  told  patient  there  would  be  a  couple  of 
weeks'  work.  He  asked  patient  whether  he  was  looking  around  for  better 
opportunities  and  patient  said  he  was.  Patient  was  afraid  if  he  put  his 
salary  too  high  he  would  not  get  the  job  so  he  gave  $25.00  as  his  price  and 
Mr.  Lambert  said  "All  right,  if  I  have  to  pay  that,  I  will."  Patient  seems 
pleased  that  he  has  a  definite  opening  and  agreed  to  get  in  touch  with 


622  APPENDIX    A 

1920 

visitor  soon  to  let  her  know  how  he  likes  it.  He  agreed  to  let  the  various 
agencies  to  which  he  applied  for  work  know  that  he  is  terhporarily  em- 
ployed, but  that  he  is  still  looking  about  for  better  opportunities. 

February  11. 

Johnston-Abbott  Mills,  Chief  Inspector,  Mr.  Fabian,  writes  that  he  saw 
his  employment  manager,  Mr.  John  Durand,  on  February  9,  who  says  he 
is  taking  on  men  right  along  and  advises  that  patient  call  at  his  office  so 
that  he  may  talk  with  him  and  find  out  for  what  work  he  is  adapted. 
Lawrence  is  not  an  unattractive  city  for  a  factory  worker  and  but  few  of 
the  workers  need  to  pay  carfare. 

February  11. 

Johnston-Abbott  Mills,  Chief  Inspector,  Mr.  Fabian,  in'ritten  to,  stating 
that  visitor  would  let  him  know  in  about  two  weeks  what  patient's  plans 
are  and  suggesting  that  possibly  at  that  time  patient  would  be  glad  to  see 
Mr.  Durand. 

February  14. 

Patient's  wife  telephoned  that  patient  asked  her  to  let  visitor  know 
that  he  liked  his  work  very  much  and  that  he  is  "feeling  good"  and  says 
the  work  is  "pretty  easy."  His  hours  are  9  to  5  and  Saturdays  until  one. 
Emma  is  well  now  and  expects  to  return  to  school  on  February  16.  Dr. 
Sullivan  said  Emma  had  had  a  bilious  attack  which  she  occasionally  has 
about  a  week.  He  has  advised  about  Emma's  diet,  and  of  a  number  of 
things  Emma  will  not  eat,  such  as  cereals,  and  she  has  just  begun  to  drink 
milk.  The  doctor  says  that  her  enlarged  tonsils  should  be  removed  soon. 
Visitor  urged  her  to  take  Emma  to  a  hospital  O.  P.  D.  soon  to  make  an  ap- 
pointment for  tonsillectomy,  as  otherwise  it  might  be  difficult  to  make  one 
before  summer.  Informant  agreed  to  do  this.  Patient's  wife  is  well  now. 
Her  back  bothered  her  for  a  few  days  as  she  had  strained  it  by  some 
heavy  lifting.  Informant  agreed  to  ask  patient  to  telephone  visitor  on 
February  16  at  noon. 

February  14. 

International  Optical  Company,  Lexington,  Employment  and  Service 
Department,  Miss  Henderson,  writes  that  patient's  application  and  visitor's 
letter  have  been  received.  Informant  hopes  to  be  able  to  find  some  work 
for  patient  and  will  keep  him  in  mind,  letting  him  know  if  she  has  an 
opening  which  she  thinks  patient  would  like. 

February  16. 

Patient  telephoned  at  noon.  He  likes  his  present  work  which  he  says 
"is  easy  enough,"  there  being  "nothing  complicated"  about  it.  His  boss  is 
the  head  bookkeeper,  Mrs.  Judson.  When  asked  how  he  gets  along  with 
her  he  replied,  "I  can  get  along  with  anybody,"  and  that  he  pretends  he 
doesn't  know  anything  and  does  things  her  way.  He  is  catching  up  with 
past  bookkeeping  as  far  back  as  last  July  which  has  been  poorly  done  by 
his  predecessors.  There  seems  to  be  no  question  of  permanent  work  and 
he  says  he  sees  about  ten  days  more  ahead.  He  asked  visitor  to  get  in 
touch  with  Boston  University  again,  and  to  look  into  openings  recently 
advertised,  one  at  the  Federal  Furniture  Company,  356  Benton  St.,  and  the 
other  at  Dunton-Bcrry's. 

His  wife  begins  work  to-night,  intending  to  keep  at  it  until  he  has  a 
permanent  job.     For  the  present,  patient  feels  that  she  is  better  off  there 


APPENDIX    A  623 

1920 

than  not  working  as  it  distracts  her  mind  from  somewhat  strained  relations 

with  the  landlady. 

February  16. 

Federal  Furniture  Company,  356  Benton  St.,  telephoned  to.  The  man 
who  does  the  hiring  stated  that  the  firm  is  a  credit  house  needing  a  book- 
keeper, but  a  younger  man  than  patient,  as  all  the  office  force  is  young.  He 
added,  "They  do  all  the  work  I  want  them  to." 

February  16. 

Dunton-Berry's  Department  Store  telephoned  to.  The  employment 
manager  was  out,  but  the  head  bookkeeper,  Mr.  Hathaway,  stated  that  he 
has  an  opening  for  an  assistant  auditor  at  $35.00.  Considerable  bookkeep- 
ing experience  and  a  man  of  much  common  sense  is  required.  There  are 
about  40  applicants  and  informant  will  have  to  decide  on  them  soon. 
Patient  should  send  in  a  formal  application. 

February  17. 

Patient  telephoned  to  and  agreed  to  write  Dunton-Berry's  to-day  re- 
garding the  opening  in  the  bookkeeping  department. 

February  19. 

Patient  mritten  to,  suggesting  that  he  take  a  half  day  off  to  apply  for 
clerical  opening  at  Allison's  and  enclosing  a  letter  of  introduction  to  the 
office  manager  there. 

February  24. 

Patient's  zvife  telephoned  that  patient  would  telephone  visitor  at  noon. 
Informant  would  like  to  live  in  North  Beverly  as  she  has  friends  of  her 
girlhood  living  there.  H  patient  should  work  in  Beverly  he  would  first 
commute  from  Boston  before  the  family  moved.     They  are  all  well. 

February  24. 

Patient  telephoned  stating  that  he  will  ask  for  a  day  off  to  look  into 
openings  at  the  Allison  Manufacturing  Company  and  the  Johnston-Abbott 
Shops.  Visitor  agreed  to  mail  patient  a  letter  of  introduction  to  the 
Johnston-Abbott  shops. 

Patient  is  sure  his  present  work  is  temporary,  lasting  only  a  few  days 
more,  as  the  head  bookkeeper  practically  said  that  this  morning.  Patient's 
job  has  been  to  catch  up  with  her  past  bookkeeping.  She  has  been  careless, 
has  let  things  slide,  and  does  not  fully  understand  her  work.  She  has  not 
made  a  trial  balance  for  the  last  eight  months.  Patient  has  liked  the  work, 
however,  and  has  felt  well  except  that  he  has  not  slept  very  well.  He  is 
sure  that  when  he  has  a  permanent  job  he  will  be  O.  K. 

February  24. 

Johnston-Abbott  Shops,  Chief  Inspector,  Mr.  Doyle,  "Written  to,  stating 
that  patient  would  apply  soon  to  Mr.  Durand. 

February  26. 

Patient  telephoned  that  as  he  has  to  take  off  an  hour  to-morrow  morn- 
ing to  complete  a  piano  deal,  he  will  not  visit  Lawrence  and  Beverly  until 
March  i.  Yesterday  he  arranged  for  his  landlady  to  purchase  a  piano  at 
the  Hotel  Bellingham  as  a  result  of  an  advertisement  he  saw  in  the  paper. 


624  APPENDIX    A 

1920 

This  deal  will  give  patient  $20  commission.     Patient  is  not  yet  sure  when 
the  work  will  terminate  but  says  it  may  any  time. 

February  2"]. 

Boston  University,  Mr.  Warren,  seen  at  Mr.  Jenkin's  class  for  employ- 
ment managers.  He  knows  of  no  opening  for  patient  and  admits  that 
patient's  age  is  much  against  him.  Apparently  no  opening  can  be  expected 
from  this  source. 

March  i. 

Patient  telephoned  early  in  the  afternoon  that  he  had  spent  the  morn- 
ing in  Beverly  at  the  Allison  Manufacturing  Co.,  but  due  to  the  present 
difficulties  in  transportation,  could  not  reach  Lawrence  the  same  day.  It 
is  too  late,  however,  to  return  to  his  work  in  Chelsea  to-day. 

This  morning  he  waited  one  hour  and  a  half  for  the  office  manager, 
Mr.  Van  Horn,  who  told  patient  he  would  look  over  various  clerical  posi- 
tions to  see  whether  patient  would  fit  in.  As  most  of  the  bookkeeping  is 
done  by  girls,  there  would  be  no  opportunity  at  bookkeeping.  He  was  well 
impressed  by  patient's  desire  to  live  in  Beverly  and  be  permanent  with  the 
firm.  He  asked  patient  what  salary  he  would  require  and  patient  said  he 
would  start  at  $25  if  there  was  every  opportunity  for  advancement; 
Mr.  Van  Horn  assured  patient  that  no  employee  was  hired  at  Allison's 
without  the  idea  of  promotion  in  mind,  and  that  the  firm  would  not  con- 
sider paying  patient  less  than  $25. 

Patient  suggested  that  visitor  write  a  letter  to  ]\lr.  Van  Horn,  who 
had  asked  patient  to  get  in  touch  with  him  in  about  a  week  or  ten  days  if 
patient  had  not  heard  from  him. 

When  patient  announced  that  he  was  not  reporting  to  work  this  morn- 
ing, the  head  bookkeeper  was  quite  afraid  that  patient  was  leaving  and  felt 
much  relieved  that  his  absence  was  only  temporary.  Patient  feels  that  he 
has  given  her  a  number  of  valuable  suggestions  for  her  bookkeeping,  and 
that  there  is  still  a  number  of  days'  work  there  for  patient.  Patient  seldom 
sees  Mr.  Lambert  and  apparently  is  responsible  only  to  the  head  book- 
keeper. 

Patient  plans  to  visit  Lawrence  soon,  but  would  prefer  to  live  in 
Beverly  as  his  summer  camp  would  be  so  near  by. 

March  2. 

Allison  Manufacturing  Company,  Manager,  Mr.  Van  Horn,  written  to, 
asking  him  to  let  visitor  know  what  he  decides  about  patient,  and  assuring 
him  that  patient  is  ready  for  responsible  work. 

March  6. 

Johnston-Abbott  Shops,  Chief  Inspector,  Mr.  Doyle,  writes  that  he 
spoke  to  Mr.  Durand  about  patient  and  hopes  patient  gets  a  good  job  there. 
Some  of  the  jobs  are  good  and  some  seem  hard  to  informant. 

March  8. 

Patient  telephoned  that  he  has  not  heard  from  the  Allison  Mfg.  Co. 

March  9. 

Patient  written  to,  reassuring  him  about  Allison's  and  urging  him  to 
go  to  the  Johnston-Abbott  Shops  at  once. 

March  11. 

Patient  telephoned  that  he  sees  several  weeks  ahead  of  work  where  he 
is,  and  suggested  visitor's  writing  to  Allison's  to-day.     He  was  very  dis- 


APPENDIX    A  625 

1920 

appointed  not  hearing  from  Allison's.  He  thinks  they  may  be  waiting  for 
his  letter  to  decide  on  his  merits.  He  plans  to  install  new  bookkeeping 
methods  where  he  is.  He  will  write  Beverly  to-day  and  visit  Lawrence 
soon. 

March  12. 

Patient  telephoned  that  he  is  very  discouraged,  having  received  a  letter 
yesterday  from  Allison's,  stating  that  there  are  no  openings  now  suitable 
for  patient,  but  if  there  are  later,  they  will  let  patient  know.  Patient  feels 
that  other  men  with  only  half  his  ability  are  getting  jobs  without  difficulty. 
(Patient  apologizes  for  his  conceit.)  He  wonders  whether  knowledge  that 
he  has  been  at  the  Psychopathic  Hospital  on  the  part  of  employers  has 
anything  to  do  with  it,  as  he  feels  Allison's  was  so  enthusiastic  when  he 
saw  them  ten  days  ago.  Visitor  reminded  him  that  Allison's  knew  of  his 
relations  with  the  hospital  at  the  time.  His  wife  is  not  interested  in  Law- 
rence as  she  knew  so  many  people  in  Beverly.  Patient  will,  however,  go  to 
Lawrence  this  morning.  He  is  already  in  the  North  Station  and  has  for- 
gotten to  take  visitor's  letter  with  him. 

March  11. 

Allison  Mfg.  Co.,  Office  Manager,  Mr.  Van  Horn,  written  to,  asking 
why  patient  was  not  taken  on. 

March  15. 

Patient  telephoned  that  he  was  much  disappointed  with  his  visit  in 
Lawrence.  He  waited  a  long  time  for  Mr.  Durand  who  had  only  night 
work  as  a  machinist  to  offer  patient.  This  patient  refused  though  wages 
were  not  discussed.  Patient  asked  for  Mr.  Doyle  as  head  office  man,  who 
was  not  so  identified,  but  patient  was  referred  to  Mrs.  Mahoney  in  charge 
of  the  clerks  figuring  the  payroll.  She  told  patient  she  had  only  young 
girls  and  boys  at  $15  and  $16.  Later  patient  talked  with  the  head  book- 
keeper, Mr.  Hinton,  who  said  most  of  the  bookkeeping  was  done  in  Boston. 
Patient  was  not  impressed  favorably  by  the  place,  as  even  the  office  looked 
dirty  and  the  young  employees  complained  of  the  poor  pay. 

On  returning  to  Boston  patient  applied  to  the  Federal  Employment 
Office  and  asked  to  be  kept  on  the  list.  In  his  last  letter  to  Boston  Uni- 
versity patient  asked  to  be  kept  on  their  lists  and  visitor  agreed  to  remind 
Boston  University  of  this. 

Patient  feels  it  very  much  easier  for  visitor  to  advise  than  for  him  to 
carry  out  the  advice,  but  says  he  tells  himself  he  must  keep  up  his  courage. 
He  wjll  continue  to  look  around  for  permanent  positions  as  will  visitor  also. 

March  17. 

Allison  Mfg.  Co.,  Office  Manager,  Mr.  Van  Horn,  writes  that  he  could 
not  now_  employ  patient  "in  whom  we  are  mutually  interested"  as  there  are 
no  openings  in  the  accounting  division  and  the  bookkeeping  is  done  entirely 
by  women.  Informant  wrote  patient  recently  stating  that  there  was  no 
position  now  to  "capitalize  his  previous  experience"  but  that  he  would  be 
kept  on  the  waiting  list  until  the  situation  became  better  defined. 

March  18. 

Johnston- Abbott  Shops,  Chief  Inspector,  Mr.  Doyle,  written  to,  ex- 
plaining that  patient's  interview  with  Mr.  Durand  was  not  very  satisfactory 
to  patient  and  asking  informant  to  keep  patient  in  mind  should  any  suitable 
openings  appear  soon. 


626  APPENDIX    A 

1920 

March  25. 

Patient  telephoned  to  ask  visitor  if  there  was  any  news  regarding 
future  openings.  April  i  he  plans  to  balance  the  books  at  Lambert's  and 
says  there  may  be  more  work  there  after  that.  When  his  work  is  finished 
there,  he  plans  to  go  to  the  country  a  day  or  two,  and  will  stop  off  via 
Allison's  on  his  return  home.  "What's  worth  having  is  worth  going  after." 
He  will  tell  Mr.  Van  Horn  at  Allison's  that  he  will  gladly  start  in  any- 
where in  the  firm.  Patient  inquired  for  Mr.  Warren  at  Boston  University. 
Patient  has  done  nothing  about  membership  in  the  Y.  M.  C.  A.  because  un- 
settled as  to  location.  He  plans  to  drop  his  membership  in  the  Elks  which 
he  never  enjoyed  and  which  costs  him  $12  annually.  He  feels  it  too  ex- 
pensive to  play  with  the  Elks.  In  two  or  three  weeks  he  plans  to  go  week- 
ends to  his  camp. 

March  26. 

Boston  University,  Vocational  Department,  Mr.  Warren,  visited.  In- 
formant had  an  opening  at  the  B.  D.  Cole  Leather  Company,  80  North 
Street,  where  Mr.  Kelsey  is  looking  for  a  bookkeeper  at  $25.  Informant 
has  sent  over  about  six  candidates,  none  of  whom  were  accepted.  One  at 
$25  was  too  inexperienced  and  one  at  $30  was  too  expensive,  but  in- 
formant does  not  know  what  the  drawback  was  with  the  others.  If  patient 
applies  he  can  say  he  heard  of  the  opening  through  Boston  University. 

March  26. 

Patient  zvritten  to,  advising  him  to  look  into  the  opening  at  the  B.  D. 
Cole  Leather  Company  at  once  and  report  back  to  visitor. 

April  I. 

Y.  M.  C.  A.,  Mr.  Doyle,  telephoned  to,  who  stated  that  he  could  quite 
easily  find  out  from  patient's  employer  how  satisfactory  his  work  is,  and 
that  he  will  make  such  inquiries  soon. 

April  I. 

Boston  University,  Vocational  Department,  Mr.  Warren,  telephoned  to, 
who  stated  that  it  was  more  to  the  point  for  visitor  to  telephone  the  B.  D. 
Cole  Leather  Company  than  for  informant  as  visitor  knew  patient  so  much 
better.    Visitor  agreed  to  do  so. 

April  I. 

Patient  writes  that  he  has  made  several  unsuccessful  attempts  to  tele- 
phone visitor.  On  March  29  he  called  on  Mr.  Kelsey  at  the  B.  D.  Cole 
Company  who  was  very  busy  and  talked  with  patient  but  a  few  minutes. 
Patient  says  "he  was  rather  favorably  impressed  with  me  and  gave  me  an 
application  blank  to  fill  out."  Mr.  Kelsey  did  not  explain  the  position  in 
detail.  Patient  thinks  firm  is  "a  very  nice  one"  to  work  for.  Patient 
thinks  if  Mr.  Warren  of  B.  U.  would  telephone  Mr.  Kelsey  it  might  help 
to  get  him  the  position. 

April  I. 

B.  D.  Cole  Leather  Company,  80  North  Street,  Bookkeeping  Dcpf.. 
Mr.  Kelsey,  visited  at  11  a.  m. 

Impression :  Keen  business  man,  human  interest  probably  secondary  to 
business. 

Informant  asked  visitor  her  interest  in  patient.  He  is  considering 
patient  among  two  or  three  other  candidates,  but  said  patient  did  not  im- 


APPENDIX    A  627 

1920 

press  him  very  favorably.  He  v^^ould  not  explain  this  further  than  to  say 
he  felt  patient  might  leave  for  the  liquor  business  at  any  time  prohibition 
took  a  turn  and  that  informant  preferred  a  younger  candidate.  In  favor 
of  patient  he  spoke  of  his  neat  handwriting.  It  is  difficult  novi^  to  get  good 
material  as  bookkeepers  though  plenty  of  poor  help  is  available.  The 
position  is  for  a  m,an  to  work  in  as  understudy  to  the  head  bookkeeper. 
His  work  would  be  to  connect  up  between  the  factory  and  the  office  and 
the  candidate  would  have  to  learn  both  the  factory  and  office  bookkeeping 
methods  as  well  as  have  eight  or  nine  men  under  him.  Informant  agreed 
to  send  for  patient  if  he  decided  to  consider  him. 

April  I. 

Federal  Employment  Office,  4  Cherry  St.,  visited.  There  is  no  open- 
ing for  patient. 

April  2. 

Patient  written  to,  explaining  the  result  of  the  visit  to  the  B.  D.  Cole 
Leather  Company  and  advising  patient  not  to  expect  the  opening  there 
though  he  can  keep  it  in  the  back  of  his  mind.  Letter  advised  patient  to 
visit  Allison's  soon  with  regard  to  future  employment. 

April  6. 

Patient  telephoned  his  wife  is  a  little  discouraged  about  his  not  having 
steady  work  but  she  does  not  say  much.  Patient  will  telephone  Mr.  Kelsey 
of  the  B.  D.  Cole  Leather  Company  to-morrow  to  see  if  there  are  any 
chances  there  and  will  write  Allison's  that  he  plans  to  visit  on  April  12. 
Patient's  wife  has  intended  to  make  an  appointment  at  the  Children's  Hos- 
pital for  the  removal  of  Emma's  tonsils  and  patient  will  urge  her  to  do  so 
soon. 

April  7. 

Federal  Employment  Office,  4  Cherry  Street,  Mr.  Brown,  visited,  who 
has  no  openings  for  patient  as  a  bookkeeper.  Prospects  in  this  line  have 
not  improved. 

April  8._ 

Allison  Mfg.  Co.,  Office  Manager,  Mr.  Van  Horn,  written  to.  explain- 
ing that  patient  would  visit  on  April  12  and  that  he  would  be  willing  to 
start  in  at  any  time  in  any  line  there,  as  he  was  especially  interested  in 
the  firm  because  of  its  promise  of  advancement.  Letter  asked  that  in- 
formant put  patient  in  touch  with  the  employment  department  if  informant 
had  no  openings  himself. 

April  8._ 

Patient  written  to,  explaining  that  visitor  was  writing  Allison's. 

April  9. 

Y.  M.  C.  A.,  Mr.  Doyle, ^  telephoned,^  stating  that  patient  has  adapted 
himself  very  well  to  conditions,  according  to  patient's  employer,  and  has 
helped  tide  over  the  situation  very  well.  Patient's  work  there  will  soon  be 
finished  and  informant  will  keep  patient  in  mind  for  a  similar  opening. 

April  12. 

Patient  reported  to  visitor  at  11:30,  stating  that  his  plans  had  been 
changed   somewhat.     In  yesterday's   Globe  he   saw  an  advertisement  for 


628  APPENDIX    A 

1920 

various  types  of  help  at  the  Standard  Drug  Company,  among  them  ac- 
countants and  bookkeepers.  He  decided  therefore  to  apply  there  the  first 
thing  in  the  morning,  and  waited  with  a  "seething  mob"  from  8  A.  m.  until 
10:30  before  he  was  seen.  The  employment  manager  had  him  fill  out  an 
application  blank  and  then  told  patient  that  undoubtedly  they  could  fit  him  _ 
into  the  organization  and  that  the  man  patient  should  see  would  not  be  in 
until  to-morrow.  The  employment  manager  said  he  would  look  up  patient's 
references  in  the  meantime.  Patient  put  down  as  his  minimum  salary 
$27.50  per  week.  Patient  seemed  quite  enthusiastic  over  the  interview 
there.  He  plans  to  go  at  once  to  apply  at  Allison's  this  afternoon.  He 
spent  the  week-end  on  his  little  farm  and  his  farmer  friend  Henry  told 
patient  of  an  opening  at  $4  a  day  to  clear  the  woods  on  the  estate  of  the 
millionaire,  Henderson,  near  Lexington,  which  would  last  until  the  summer, 
n  no  definite  opening  materializes  in  a  week  when  patient  expects  the  posi- 
tion at  Lambert's  to  end.  patient  will  take  this  job  in  the  woods,  as  he  does 
not  want  to  be  idle  at  all  especially  considering  the  high  cost  of  living. 
Patient's  wife  cleaned  up  at  the  camp  preparatory  to  living  there  for  the 
summer.  The  family  expect  to  go  to  camp  again  next  week-end  when 
patient  will  do  his  plowing.  Patient  says  he  feels  pretty  well  but  still 
sleeps  only  fairly  well,  waking  up  early  and  then  only  dozing  for  the  rest 
of  the  morning. 

Patient  is  sure  his  present  employer  will  give  him  a  good  reference 
and  when  patient  lecently  called  up  Mr.  Stratton  of  the  Stratton  Piano 
Company  relative  to  the  sale  of  a  piano,  patient  was  reassured  by  Mr. 
Stratton  that  he  would  give  patient  a  good  reference  at  any  time.  Patient 
stated  that  it  was  difficult  to  reach  visitor  by  telephone  especially  since 
there  is  no  booth  in  his  office.  He  will,  however,  let  visitor  know  the  results 
of  his  applications  at  Allison's  and  the  Standard  Drug  Company.  He 
telephoned  the  B.  D.  Cole  Leather  Company  a  few  days  ago  and  Mr.  Kel- 
sey  said  he  had  filled  the  position  that  morning.  Patient  then  asked  Mr. 
Kelsey  why  patient  had  not  been  selected,  adding  that  perhaps  patient  was 
asking  state  secrets.  Mr.  Kelsey  did  say  it  was  not  because  of  patient's 
age  but  would  give  no  further  reply.  Visitor  agreed  with  patient  that  the 
position  at  clearing  the  woods  would  be  good  in  case  no  further  opening 
was  at  hand  as  patient  said  he  would  feel  free  to  leave  it  at  any  time. 

April  20. 

Patient's  former  employer,  Lambert  Real  Estate  Co.,  telephoned  to. 
Patient  left  there  on  April  17.  The  clerk  volunteered  that  patient  had  done 
very  good  work  and  that  they  thought  he  was  going  to  work  at  Allison's 
and  live  at  his  camp. 

April  20. 

Patient's  zvife  telephoned  to.  Patient  went  out  to  Lexington  to-day  to 
look  up  Allison's  and  will  be  home  to-night.  Visitor  left  word  for  patient 
to  write  at  once  or  telephone  regarding  his  work  plans.  Further  details 
could  not  be  discussed  over  the  telephone. 

April  22. 

Patient's  zvife  telephoned.  A  week  ago  patient  was  told  at  Allison's 
to  report  April  20  as  the  firm  thought  they  could  then  place  him  in  the 
stockroom.  He  planned  to  return  home  the  evening  of  April  20  for  his 
work  clothes  if  put  to  work,  but  nothing  has  been  heard  from  him.  It_  is 
probably  about  a  half  hour's  ride  from  his  camp  to  Allison's,  from  which 
he  planned  to  comniute.     loformant's  plans   will   depend  upon  how   well 


APPENDIX    A  629 

1920 

patient  likes  Allison's  if  he  is  working  there.     She  will  try  to  get  news  of 
patient  for  visitor  as  soon  as  possible. 

lApril  26. 

Patient  reported  to  visitor,  stating  that  he  is  well  and  busy,  but  that 
he  still  has  vague  fears  at  times,  which  he,  however,  has  been  able  to  con- 
trol. His  wife  is  still  working,  and  his  wife's  sister  is  still  helping  some- 
what financially.  For  example,  she  visited  patient's  camp  last  week-end, 
bringing  out  a  good  supply  of  food,  and  paying  patient's  son's  transporta- 
tion.    Patient  hopes  to  pay  her  back  later. 

Patient  asked  visitor's  advice  about  his  work.  The  last  two  times  he 
applied  at  Allison's,  word  was  sent  to  him  from  Mr.  Van  Horn  that  he 
was  too  busy  to  see  patient,  and  that  he  should  report  back  in  a  week. 
Patient  wondered  therefore  if  that  was  the  real  explanation  or  whether 
the  firm  has  no  interest  in  patient. 

The  Standard  Drug  Company,  where  he  reported  again  to-day,  said 
that  patient's  name  is  on  the  waiting  list.  They  have  selected  no  clerks 
or  bookkeepers  as  yet,  this  being  up  to  the  department  heads. 

Mr.  Lambert  has  sent  for  patient,  asking  patient  what  salary  he  would 
require  to  do  the  work  he  did  temporarily  as  a  permanent  job.  The  present 
bookkeeper  has  already  become  nervous  on  the  job  since  patient  left, 
because  she  finds  it  beyond  her  ability  to  keep  the  books  straight.  Patient 
stated  $35  as  his  salary  and  said  to  visitor  if  no  other  opening  was  avail- 
able, he  would  take  it,  but  he  feels  it  is  a  "nerve-racking"  job.  The  em- 
ployer keeps  one  book  where  three  are  really  necessary,  hence  making  the 
bookkeeping  complicated.  Three  books,  though  simpler,  would  entail  extra 
work  which  the  employer  is  unwilling  to  pay  for.  Complications  come  in 
through  the  fact  that  there  are  really  three  different  funds  to  account  for 
and  the  employer  is  constantly  borrowing  from  one  fund  for  another.  If 
patient  took  the  job,  he  fears  he  would  need  to  start  on  overtime,  but  visi- 
tor firmly  said  he  could  not  do  this,  and  if  overtime  is  necessary  must  have 
assistants.  The  present  bookkeeper  Mr.  Lambert  plans  to  shift  into  other 
work  in  the  office.  Patient  wonders  how  she  would  feel  toward  patient's 
keeping  her  position.  He  suggested  to  Mr.  Lambert  that  both  Mr. 
Lambert  and  the  insurance  man  spend  too  much  time  in  the  office,  and 
that  if  patient  took  the  position  he  thought  he  could  undertake  some  of 
their  office  work,  such  as  answering  general  questions  about  real  estate, 
and  making  appointments  for  interested  parties  with  his  employer.  Mr. 
Lambert  will  decide  by  noon  of  April  28  whether  he  can  pay  patient  the 
salary  of  $35  or  not. 

Patient  would  prefer  working  for  some  large  firm  such  as  Allison's, 
as  he  feels  a  smaller  firm  can  offer  only  a  less  secure  job.  After  visitor's 
telephoning  Allison's,  patient  agreed  to  get  in  touch  with  visitor  late  to- 
morrow morning. 

April  26. 

Allison  Mfg.  Company,  Lexington,  OMce  Manager,  Mr.  Van  Horn, 
telephoned  to,  and  stated  that  patient  had  reported  the  situation  correctly 
to  visitor,  and  that  informant  is  very  sorry  he  has  been  too  busy  to  spend 
the  hour  required  to  see  whether  patient  would  fit  into  the  stockroom.  He 
is  not  willing  to  have  patient  take  another  position  without  informant's 
looking  into  the  possibilities  at  Allison's,  however.  Informant  agreed  to 
telephone  visitor  to-morrow  at  4  o'clock  what  the  situation  is. 

April  27. 

Patient  telephoned  late  in  the  afternoon,  and  agreed  to  do  so  again 
to-morrow  morning  as  Allison's  had  not  been  heard  from. 


630  APPENDIX    A 

1920 
April  28. 

Allison  Mfg.  Co.,  Lexington,  OfUce  Manager,  Mr.  Van  Horn,  tele- 
phoned to  at  10:30  A.  M.  Informant  apologized  for  not  telephoning  visitor 
yesterday.  He  had  the  memorandum  on  his  desk  and  had  done  the  pre- 
liminary work ;  namely,  to  see  where  patient  would  fit  in. 

At  present  there  is  no  clerical  opening  for  patient,  but  he  can  definitely 
be  taken  on  in  the  stockroom  giving  out  orders.  _  This  work  is  largely 
physical  and  is  paid  at  an  hourly  rate,  where  patient  would  earn  about 
$20  a  week.  Holidays  and  Sundays  as  well  as  vacations  are  not  paid 
for.  Informant  would  keep  patient  in  mind  while  he  worked  in  the  stock- 
room for  advancement  to  clerical  work  either  in  the  stockroom  or  else- 
where. They  are  hard  pressed  now  in  the  stockroom  for  clerical  help  but 
informant  has  not  been  able  to  "sell"  patient  to  them  for  clerical  work 
because  of  his  age.  Informant  is  confident,  however,  that  clerical  work 
will  develop  for  patient  later  when  his  abilities  are  recognized  in  spite  of 
his  years. 

Visitor  stated  that  unless  she  notified  informant  to  the  contrary,  patient 
would  report  to  him  on  April  30.  Informant  said  that  at  that  time  he 
would  introduce  patient  to  the  employment  department  and  arrange  for 
patient  to  begin  work  on  May  3.  At  first  informant  suggested  that  if 
patient  had  a  good  opening  at  Lambert's,  he  had  better  take  it,  but  when 
visitor  spoke  of  patient's  fear  of  only  temporary  work  there,  informant 
admitted  that  at  Allison's  permanency  could  be  expected. 

April  28. 

Patient  telephoned  and  seemed  somewhat  depressed  at  the  salary 
ofifered  to  start  with  at  Allison's.  Visitor  reminded  him  that  he  could 
hardly  have  a  better  person  than  Mr.  Van  Horn  interested  in  him,  and 
pointed  out  the  advantageous  features  of  Allison's.  Patient  will  telephone 
Lambert's  about  12:30  to-day  and  will  telephone  visitor  to-morrow  morning. 
Patient  himself  will  be  allowed  time  by  Lambert's  to  make  a  decision. 
Visitor  told  patient  it  was  up  to  him  to  make  the  final  decision. 

April  29. 

Patient  telephoned,  much  discouraged.  Mr.  Lambert  had  telephoned 
to  patient's  brother-in-law  in  patient's  absence  yesterday  that  he  could  not 
meet  patient's  figure.  Patient  feels  Allison's  should  offer  him  more  as  a 
starting  figure  (in  fact,  Mr.  Van  Horn  told  him  he  could  expect  a  minimum 
of  $25),  and  that  the  promise  of  advancement  there  is  not  definite  enough. 
He  is  wondering  whether  he  should  telephone  Mr.  Lambert,  but  finally 
decided  he  would  later.  As  Mr.  Lambert  had  said  he  would  be  v/illing  to 
pay  $1,000  more  a  year,  patient  does  not  understand  why  he  is  "balking  at 
$35  a  week."  He  thinks  all  there  is  for  him  to  do  is  to  make  the  rounds 
of  the  employment  ofliccs.  Visitor  tried  to  assure  him  that  the  hardest 
part  of  his  task  was  surely  finished  ;  namely,  that  he  had  gone  the  rounds 
of  the  employment  offices  and  now  had  a  good  employer  interested  in  him 
and  that  he  could  hardly  hope  to  find  a  better  firm  than  Allison's. 

Visitor  suggested  that  patient  come  out  to  talk  with  Dr.  Jacobs.  He 
first  said  he  would  gain  nothing,  and  spoke  in  the  tone  of  a  spoiled  child. 
When  visitor  reminded  him  that  Dr.  Jacobs  was  the  doctor  to  sanction 
responsible  work  for  him,  he  admitted  he  could  lose  nothing  by  coming, 
out  to  see  Dr.  Jacobs  and  would  do  so. 

April  29. 

Patient  reported  at  3  p.  m.  to  see  Dr.  Jacobs.  Visitor  first  discussed 
the  case  with  Dr.  Jacobs,  who  felt  that  patient  could  rightly  be  discouraged 


APPENDIX    A  631 

1920 

with  an  ofifer  of  only  $20  a  week.  After  seeing  patient,  the  doctor  reported 
to  visitor  that  patient  is  in  very  good  condition,  apparently  now  having  full 
control  of  any  fears.  He  is  a  typical  psychasthenic,  being  introspective, 
overconscientious,  hesitant  about  making  decisions,  and  lacking  self-confi- 
dence. Dr.  Jacobs  says  patient's  present  problem  to  decide  would  be  hard 
for  a  normal  healthy  person,  and  that  if  patient  were  not  somewhat  worried 
over  prospects,  considering  his  age,  his  judgment  could  be  questioned.  He 
told  patient  that  he  did  not  know  the  merits  of  the  Allison  opening,  but 
that  it  likely  was  a  good  proposition   for  the  summer  at  least. 

Patient  reported  to  visitor  that  he  could  get  Dr.  Jacobs'  point  of  view; 
namely,  that  he  must  use  "mental  suggestions"  to  himself,  but  that  it  was 
harder  to  carry  out  than  others  realized.  He  will  go  to  Allison's  to-morrow 
morning  and  look  into  the  situation  for  himself.  If  the  promise  of  ad- 
vancement is  definite  enough,  he  will  take  the  position.  He  will  write 
visitor  to-morrow  evening  before  going  to  camp  for  the  week-end.  He 
feels  considerably  worried  about  the  support  of  his  family  as  he  hates  to 
have  his  wife  working,  or  his  relatives  assisting. 

He  telephoned  Mr.  Lambert  this  morning  but  found  him  out,  but  does 
not  plan  to  telephone  again  as  patient  says  "I  have  forgotten  all  about  that 
place  now,"  evidently  considering  the  deal  closed  there. 

May  3. 

Patient  writes  that  he  is  to  start  in  at  the  Allison  Company  on  May  3, 
beginning  in  the  stockroom,  stating  that  "Mr.  Van  Horn  promises  to  see 
that  I  get  proper  advancement  if  deserving  of  it." 

May  3. 

Patient  written  to,  stating  that  visitor  feels  he  has  made  a  wise  choice, 
expressing  the  need  of  recreation,  and  asking  him  to  report  frequently 
regarding  the  progress  of  his  work. 


632  APPENDIX    A 


Case  94 
PSYCHOPATHIC   HOSPITAL 

SOCIAL   SERVICE 
NUMBERS    562 

FILE  NUMBER  5720      NAME     Harriet  Nelson  Farmer* 

0.  p.  D.    NUMBER   3838 

Residence    44  Stevens  St.,  Roxbury. 

Correspondent    Mother,  Frances  Ordway  Farmer,  at  above  address. 
Sex    F  Age    28  Color    W 

Civil  condition     S  Place  and  date  of  birth     England, 

Religion     Protestant  1887 

Occupation     Compositor   (typeset- 
ter) 
Time  IN  Boston    22  yrs.  In  Mass.    22yrs.     In  U.  S.    22yrs. 

Previous  addresses 

107  Downing  Street,  Boston 

63  Revere  Street,  Boston 
When  know^n  to  social  service     11/30/15;  3/12/18;  6/9/19 
When  discharged  from  social  service     12/31/17;  4/24/18 
Reason  for  being  known  to  social  service     Supervision 
Report  from  confidential  exchange    No  record 

Name  of  father     Henry  (deceased) 

Address 

Name  of  mother     Frances 

Address     44  Stevens  St.,  Roxbury 

Name  of  spouse 

Address 

Names  and  ages  of  children  or  siblings 

Frederick  (died  in  infancy) 

Florence,  34 

Benjamin,  32 

Bernard,  30 

Patient,  28 

Admitted  to  house     10/31/15  Authority  Chap.   174 

Discharged     12/8/15  Admitted  to  o.  r.  d.     1/19/16 

Diagnosis  Condition     Unchanged 

Not  insane — not  feeble-minded 

(Psychopathic  Personality) 
Social  Symptoms  Date    3/1/16 

Inebriety 

Fabrication 

Lying 

Suicidal  attempt 

Non-support  of  mother 

Insufficient  wage 

Friendlessness 
Social  Diagnosis  Date    3/1/16 

Vitia    (Bad   Habits)  +  Morbi    (Disease) 

*  All  names  used  in  this  record  are  fictitious. 


APPENDIX    A  633 


PSYCHOPATHIC  HOSPITAL 

SOCIAL   SERVICE 

NO.  S-562  NAME     Harriet  Nelson  Farmer 

ADDRESSES 
Patient: 

Gordon  Home, 

55  Dix  Street. 
Relatives: 

Mother,  Mrs.  Frances  Ordway  Farmer, 

44  Stevens  St.,  Roxbury. 

Sister,  Florence  Farmer, 
44  Stevens  St.,  Roxbury. 

Employer,  Miss  Nancy  Stowell,  Charles  St, 

Brother,  Benjamin  Farmer, 
Newton  St.,  Nashua,  N.  H. 

Brother,   Bernard   Farmer, 
Dover,  Mass. 

Minister,  Mr.  Young,  Channing  Church, 
Day  St.,  Roxbury. 
Residence,  York  St.,  Roxbury. 


PSYCHOPATHIC  HOSPITAL 

SOCIAL   SERVICE 

NO.  S-562  NAME    Harriet  Nelson  Farmer 

EXPENSE  SHEET 

Expenditures 
12/24/15  Tie  for  Christmas. .  .$  .25 
1/26/15  Material  for  sewing 

(for  another  patient)    1.29 

2/19/16  Theater  tickets 1.50 

4/5/16  Theater  tickets i.oo 

4/6/16  Bath  spray 59 

4/8/16  Out-of-work  pay 50 


$5.13 


634  APPENDIX    A 


PSYCHOPATHIC   HOSPITAL 

SOCIAL    SERVICE 


NO.     S-562  NAME    Harriet  Nelson  Farmer 

SUMMARY 
1916 

January  30. 
Social  History: 

Patient  is  an  English  woman  of  28,  who  has  lived  in  the  United  States 
22  years ;  in  Boston  22  years.  She  has  a  sister,  aged  34,  and  two  brothers, 
32  and  30  years  of  age.  Patient  was  eight  years  old  when  her  mother 
separated  from  her  father  because  he  was  found  to  be  maintaining  another 
wife  and  family  in  the  city.  Children  were  boarded  about  a  year  by  a 
children's  agency  until  the  mother,  who  was  and  still  is  an  invalid,  gained 
strength  to  reestablish  the  home.  Family  were  then  supported  by  two 
older  children.  Several  years  ago  both  brothers  married  and  left  patient 
and  sister  to  support  the  mother.  In  April,  1914,  the  mother  was  unable 
to  keep  up  her  housework  and  the  home  was  broken  up.  Patient  lived  in 
lodging  houses  in  the  West  End  and  sister  and  mother  with  a  married 
brother.  A  year  later,  April,  1915,  patient  was  asked  by  mother  and  sister 
to  keep  house  with  them,  but  she  refused  to  go  home  to  live  until  June, 
1915,  when  she  was  unable  to  support  herself  on  her  low  wages.  Financial 
struggle  of  the  family  has  always  been  great.  Patient  did  not  contribute 
after  leaving  home  and  only  $2  a  week  when  she  returned. 

The  mother  is  a  frail  woman,  able  to  get  about  only  on  crutches.  She 
is  religious,  generous,  and  open-hearted.  The  sister  has  worked  in  the 
same  dressmaking  establishment  for  many  years.  She  is  an  earnest,  up- 
right, and  matter-of-fact  woman  of  excellent  character.  The  older  brother 
who  lives  in  Nashua  has  a  wife  and  two  young  boys.  The  brother  in 
Dover  has  a  wife  and  a  daughter  aged  ij^.  He  is  a  machinist  and  ir- 
regularly employed.  Several  years  ago  he  was  discharged  from  one  firm 
for  attempting  to  steal  money  from  the  safe.  The  family  are  all  willing  to 
do  whatever  they  can  for  patient  and  the  mother  especially  is  fond  of  her. 
They  are  discouraged  al)OUt  her.  They  reprove  her  little  and  allow  her  to 
have  her  own  waj-  because  they  arc  afraid  of  her  tales  of  abuse. 

The  mother  and  sister  have  two  rooms,  a  bath  and  a  kitchen  in  a 
house  on  a  pleasant,  quiet  residence  street  of  Dorchester. 

Patient  went  to  school  in  Boston  through  the  grammar  grades. 

Up  to  a  year  ago  patient  had  been  a  typesetter  in  the  same  place  for 
eleven  years  and  earned  $12  a  week.  Since  then  she  has  worked  in  two 
candy  factories  for  $5  a  week.  Previously  she  worked  in  an  office  and  a 
laundry,  a  short  time  in  each.     Patient  has  about  $50  savings. 

She  is  an  ardent  Episcopalian,  though  she  was  brought  up  a  Unitarian. 

When  the  home  was  first  broken  up,  a  woman  prominent  in  the  Boston 
school  department  was  interested  in  the  family  and  became  guardian  to 


APPENDIX    A  635 

1916 

the  children.     For  the  past  two  years  St.  James  Church  with  the  aid  of 

York   House  has   tried   to   supervise   and   guide   patient. 

Physical  History: 

Patient  had  normal  birth  and  development,  with  exception  of  walking 
a  little  late.  She  had  measles  in  childhood,  diphtheria  at  five,  and  several 
attacks  of  appendicitis  (no  operation).  Patient  wears  glasses.  She  has 
some  headaches.  Her  teeth  are  in  bad  condition.  She  is  subject  to  neu- 
ralgia. Examination  here  shows  a  poorly  nourished  condition.  Question 
of  anemia.     Wassermann  test,  blood  serum  negative. 

In  appearance,  she  is  short  and  slight,  and  is  usually  pale.  She  is  the 
wiry  type  with  normal  endurance. 

Father  died  in  Westboro  State  Hospital  of  general  paralysis.  Mother 
is  an  invalid  and  has  had  spinal  curvature  from  childhood.  About  twenty 
years  ago  she  was  treated  for  syphilis  contracted  from  patient's  father. 
Heredity  otherwise  negative  or  unknown. 

Mental  History: 

Patient  was  an  average  scholar.  She  reads  much  good  literature,  Les 
Miserables  and  other  classics.  For  the  past  two  years  patient  has  been 
excessively  alcoholic,  drinking  alone  in  her  own  room  and  going  several 
times  to  priest,  or  York  House  workers,  under  the  influence  of  liquor. 
She  has  been  untruthful  and  unreliable,  telling  many  things  about  mis- 
treatment by  her  family  which  have  no  basis  in  fact.  She  has  told  scan- 
dalous stories  about  the  Episcopal  priest  to  whom  she  confessed  and  about 
the  other  church  members.  She  has  fabricated  stories  of  attentions  of 
men.  For  a  time,  an  unattractive  young  man  paid  her  attention,  but  he 
soon  let  her  alone.  Patient  talks  constantly  and  is  aggressive  toward 
people  with  whom  she  comes  in  contact.  Girls  in  church  club  would  not 
come  if  she  were  to  be  there.  She  is  lazy,  slovenly,  and  thoughtless.  At 
home,  she  leaves  all  the  housework  to  her  mother  and  sister,  and  expects 
them  to  sew  and  wash  for  her  as  well.  She  stays  in  bed  late.  Patient  and 
sister  are  uncongenial,  but  patient  is  fond  of  mother.  She  is  depressed 
at  menstrual  periods. 

A  short  time  before  admission,  she  had  put  her  name  and  address  into 
a  package  of  peanuts  while  working  in  a  candy  factory.  As  a  result,  she 
entered  into  correspondence  with  a  man  in  Springfield  whom  she  decided 
to  marry.  He  turned  out  to  be  65.  Patient  showed  much  disappointment 
at  the  outcome  of  this  affair. 

Patient  was  sent  to  this  hospital  after  an  attempt  at  suicide.  On  this 
day,  nothing  unusual  had  been  noticed  in  patient's  behavior.  She  had 
never  threatened  suicide,  and  had  not  shown  great  depression.  After  going 
to  town  that  morning,  she  lunched  with  her  mother,  who  then  went  to  her 
room  to  rest.  A  few  hours  later  the  mother  was  notified  that  patient  had 
taken  Paris  green,  and  had  gone  immediately  to  a  doctor's  ofifice.  She  was 
taken  to  the  City  Hospital,  and  from  there  was  sent  here  for  observation. 
Patient  said  she  had  bought  the  Paris  green  for  an  insecticide  and  took  it 
because  she  felt  discouraged  with  her  own  life  and  her  mother's  physical 
condition. 

In  typesetting  patient  was  fair,  but  was  considered  physically  not  fitted 
for  the  work.  She  was  laid  ofif  from  monotype  with  the  introduction  of 
more  linotype  machinery. 

In  other  places  of  employment  she  was  liked  and  considered  good. 
Each  place  she  left  for  a  better  place. 

Examination  here  shows  her  to  grade  15  years  plus  on  the  Point  Scale 
and  125^  years  on  the  Binet. 


636  APPENDIX    A 

1916 

Diagnosis:  Not  Insane — Not  Feeble-minded  (Psychopathic  Person- 
ality). 

November  30. 
Recommendations  in  regard  to : 

Social  Condition:  Patient  should  be  kept  away  from  her  own  home 
except  for  visits.  Her  family  should  be  made  to  understand  and  tolerate 
her  peculiarities. 

Keep  her  supplied  with  interesting  handwork.  Send  to  theater  occa- 
sionally and  try  to  have  her  be  with  girls  her  own  age  through  living  with 
them  and  through  church  clubs. 

Next  season  try  to  arrange  for  night  high  school  or  some  industrial 
class.     Suggest  books  and  keep  patient  supplied  with  list  of  free  lectures. 

Physical  Condition:  Regularity  of  meals  and  a  proper  diet  should  be 
arranged.     Encourage  daily  bathing. 

Further  medical  care  at  a  general  hospital  ( ?  of  anemia)  is  recom- 
mended.    Teeth  should  be  filled. 

Mental  Condition:     Encourage  and  commend  patient  in  all  her  efforts. 

Congenial  work  should  be  found  and  signs  of  mental  or  "physical 
fatigue  watched  for. 

Patient  should  report  to  Out-Patient  Department  monthly  in  the  begin- 
ning. Special  attention  should  be  given  to  any  depression  lest  it  lead  to 
drinking.  Patient's  complaints  and  difficulties  with  family  should  be  mini- 
mized and  her  friendly  attitude  maintained. 


SUMMARY  OF  RESULTS  IN   SIX  MONTHS 

April  5. 
Social: 

Since  leaving  the  hospital,  patient  has  lived  at  the  Gordon  House  in  a 
double  room.  Every  Saturday  afternoon  and  Sunday  she  has  spent  at 
home  and  last  two  months  she  has  been  staying  over  night.  Occasionally 
she  has  spent  the  day  at  her  brother's  in  Dover.  For  two  months  she  has 
been  giving  her  mother  50  cents  or  $1  weekly.  She  takes  her  dainties  often. 
She  has  put  about  $10  in  the  bank. 

From  December  28  to  March  11  patient  worked  at  piece  work  in  a 
factory  where  the  work  was  irregular  and  where  she  could  earn  a  maxi- 
mum of  about  $7.50  a  week.  On  March  11  patient  started  time  work  in 
another  factory  where  she  pasted  labels  and  packed  bottles  for  $6  a  week 
with  advance  in  wage  later.  This  work  was  uncongenial  to  her  and  on 
April  24  she  found  a  position  in  her  old  trade  of  typesetting  at  $8. 

Evenings  patient  stays  in,  usually  either  reading  or  sewing.  She  has 
been  with  her  sister  to  a  church  entertainment,  to  the  theater,  and  some 
public  meetings.  Occasionally  she  goes  to  the  Settlement  House  forum 
meetings. 

In  the  House  the  girls  like  her  and  come  into  her  room  evenings. 
They  have  spreads  and  very  jolly  times.  In  February  her  roommate,  a 
blind  girl  to  whom  she  was  devoted,  left,  and  she  had  a  young  Polish  girl 
until  Slay,  when  she  has  been  alone.  At  work,  she  has  made  some  girl 
friends. 


APPENDIX    A  637 

1916 

In  January  patient  joined  her  people's  Unitarian  Church,  but  she  has 
attended  only  comparatively  few  times.  She  went  to  the  Episcopal  Church 
fairly  regularly  for  four  months  without  telling  her  family,  but  now  goes 
less  often. 

Physical: 

On  discharge,  patient  was  referred  to  the  Massachusetts  General  Hos- 
pital with  a  question  of  anemia.  She  was  in  the  hospital  from  December 
13  to  17  and  was  found  to  be  not  anemic.  She  has  had  her  teeth  cleaned 
and  some  fillings  done  at  the  Harvard  Dental  School  at  times  when  she  has 
been  out  of  work.  She  has  reported  monthly  to  the  Out-Patient  Depart- 
ment. 

Patient  eats  two  meals  at  the  House,  and  usually  fruit  and  cocoa  at 
night.     Luncheon  she  takes  with  her  to  work. 

Patient  walked  to  and  from  work  a  distance  of  about  three  miles  in 
her  first  two  places.  Now  she  walks  occasionally  though  it  is  about  five 
miles.  At  present  work  she  sits  on  a  high  stool,  but  stands  from  choice 
some  of  the  time.  She  goes  to  bed  earlj^  particularly  when  work  has  been 
physically  fatiguing.     A  bath  spray  has  facilitated  daily  bathing. 

Patient  had  difficulty  with  menstruation  and  has  been  to  consult  Dr. 
Green,  a  woman  physician  at  the  hospital,  about  it. 

Mental: 

There  has  been  no  evidence  of  patient's  telling  lies  or  elaborate  fabri- 
cations. She  exaggerates  her  own  good  efforts  in  everything  she  does  and 
gives  accounts  of  her  excellent  conduct.  There  has  been  no  open  conflict 
between  her  sister  and  herself.  Patient  has  not  been  drinking,  nor  has  she 
mentioned  suicide. 

She  has  appeared  to  be  happy  and  fairly  contented  except  for  her 
desire  to  stay  at  home  over  Saturday  nights.  This  had  not  been  allowed 
for  several  months  because  patient  would  stay  in  bed  late  and  impose 
on  the  family.  Her  mother's  invalidism  worries  her  and  often  she  gets 
discouraged  or  sad  over  it. 

Her  last  roommate  was  a  rather  stupid  and  ill-mannered  girl  and 
patient  took  much  pleasure  in  training  her  manners  and  habits. 

Patient  has  shown  herself  to  be  very  generous.  She  was  glad  to  make 
two  garments  for  another  patient  known  to  visitor  and  she  has  made 
several  presents  for  visitor.  She  is  good  with  handwork  of  all  sorts  and 
enjoys  spending  her  time  this  way. 

When  discouraged  and  blue  she  had  two  long  talks  with  the  Chief  of 
StaflF. 
HA/C 

PSYCHOPATHIC  HOSPITAL 

SOCIAL   SERVICE 

NO.  8-562  NAME    Harriet  Nelson  Farmer 

HISTORY 
1915 
December  3. 

Patient's  story:     Patient  gives  following  places  of  employment: 

1.  T.  S.  Davis,   180  Young  St.,  office  work.     Left  for  better  wages. 

2.  One  year  1904-5 — Charter  Hill  Laundry.  Laundry  work.  (Place 
burned.)     Left  because  work  was  too  hard. 


638 


APPENDIX    A 


I915 

'    3.    Nine  years  to  November,  19:4 — Sampson  Press.     Left  with  intro- 
duction of  a  new  machine  requiring  fewer  girls. 

4.  December,  1914 — G.  I.  Eaves,  candy  work.  Left  because  rush  sea- 
son was  over. 

5.  February,  1914-October,  1915 — Tyson  Brand  Co.,  Cross  St.,  Cam- 
bridge, packing.  Left  because  employees  were  rough  and  wages  low. 
$'.50  a  week. 

Schools  were  as  follows : 

r.    James  B.  Baker  School  (Grammar  School),  finished  1904. 

2.  East  Boston  High  School  (night),  1905. 

3.  Dixon's  Commercial  School  (night),  1905,  complete  course. 

Patient  has  always  lived  with  her  family  until  August,  1914,  when  they 
broke  up  because  of  mother's  ill  health.  She  has  a  married  brother, 
Arthur,  aged  32,  living  on  Newton  St.,  Nashua,  N.  H.  Of  his  wife  patient 
is  fond  and  feels  at  home  there.  He  has  two  boys.  Another  brother, 
Bernard,  is  married  and  has  one  girl  and  lives  in  Dover.  Patient  does  not 
know  his  wife  well  nor  feel  at  home  with  her.  They  have  asked  her  to 
come  and  stay  there  when  she  leaves  here,  but  she  is  anxious  to  go  to 
work.  "I  think  I  might  go  insane  if  I  stay  out  of  work  nuch  longer." 
Patient  and  her  sister  Florence  are  not  congenial.  Sister  is  "older  and 
more  set  in  her  ways"  into  which  she  tries  to  draw  patient.  Sister  goes 
out  and  takes  an  interest  in  suffrage  and  such  things  while  patient  prefers 
to  be  at  home  and  quiet. 

Since  family  broke  up  housekeeping  patient  has  lived  in  lodging  houses, 
first  at  107  Downing  St.  Room  was  $3  and  when  she  took  a  $2.50  one  in 
the  same  house  it  was  ill-kept  and  had  Ijugs  and  vermin.  On  September  18, 
1914,  she  moved  to  63  Revere  St.,  where  she  stayed  until  June,  1915.  At 
that  time  she  returned  to  her  family  (mother  and  sister)  who  started  to 
keep  house. 

Patient's  family  are  Unitarians.  She  was  confirmed  in  Christ 
Church,  East  Boston.  The  minister  there.  Rev.  Y.  K.  Elden,  has  since  left, 
but  she  keeps  in  close  touch  by  correspondence  with  Mrs.  Elden.  Patient 
has  been  going  to  St.  James  Church,  Cambridge  St.,  for  a  little  over  a  year. 
Confessions  she  has  made  to  Father  Cramer  and  ha^i  confidence  in  him 
until  lately.  When  she  confessed  drinking  he  sent  her  to  see  Miss  Kendall 
at  York  House,  but  patient  did  not  feel  she  could  enter  there.  She  has 
seen  Miss  Kendall  a  good  deal  and  trusted  her.  Has  since  heard  that  Miss 
Kendall  said  she  was  "mentally  deranged"  and  this  has  hurt  patient's  feel- 
ings. Father  Cramer  told  her  she  must  do  exactly  as  he  said  if  he  was  to 
help  her,  but  patient  was  unwilling  to  do  this.  At  one  time  Father  Cramer 
sent  an  immoral  girl  of  16  to  her  for  advice.  Patient  thinks  he  must  have 
had  confidence  in  her  to  do  such  a  thing.  Lately,  however,  he  has  prom- 
ised to  see  her,  and  has  not  done  so,  and  said  he  went  to  Roxbury  and 
found  no  one  home,  when  in  reality  he  saw  her  mother  and  upset  her 
terribly.  Her  confession  he  used  in  his  sermon.  After  the  latter  incident, 
she  made  up  a  lot  of  things  to  confess  just  to  see  whether  he  would  tell 
them,  and  he  did.  Patient  will  discontinue  connection  with  this  church. 
She  feels  she  ought  to  go  to  the  LTnitarian  Church  because  Mr.  Young,  the 
pastor,  is  taking  an  interest  in  her  and  offering  to  help.  She  cannot  believe 
their  doctrines  nor  be  satisfied  with  the  service. 

Patient  goes  out  about  two  nights  a  week.  The  other  nights  she  goes 
to  bed  8  or  earlier.  She  gets  up  about  6.  Always  she  sleeps  well  and  has 
a  normal  appetite.  When  she  had  a  room,  she  cooked  her  own  meals  there, 
and  on  Sundays,  when  she  went  to  see  her  mother  at  her  brother's,  they 
filled  a  travelling  bag  with  home-cooked  things   for  her.     From  August, 


APPENDIX    A  639 

1915 

1914,  to  May,  1915,  patient  took  a  glass  of  port  wine  ($1  a  quart)  a  day  to 
brace  herself.  She  took  raw  eggs  also.  She  found  the  wine  made  her 
nervous  so  she  stopped  it.  Had  one  glass  a  few  days  before  admission. 
She  has  no  desire  for  it. 

Patient  averaged  two  books  a  week  as  well  as  all  the  books  for  which 
she  set  up  type.  She  reads  good  books,  naming  as  examples  Last  Days 
of  Pompeii  and  Gilbert  Parker's  novels.  She  owns  a  number.  Em- 
broidery she  likes  to  do  and  makes  all  her  own  clothes,  mostly  by  hand, 
and  trims  her  hats. 

She  likes  to  be  alone  and  has  never  made  any  girl  friends  with  the 
'  exception  of  Miss  Kendall  of  York  House.  For  six  months  in  1914  she 
knew  Karl  Cauldwell  and  was  engaged  to  him,  but  he  left  town  and  wrote 
he  would  not  see  her  again.  Afterward,  she  found  out  he  was  not  a  good 
sort  so  has  not  cared  that  he  went  away.  She  had  the  friendship  of  Frank 
Illington,  who  in  September,  1914,  went  away  to  study  for  Roman  Catholic 
priesthood.  He  left  his  books  to  her.  He  was  a  fine,  good  young  man. 
At  one  time  patient  belonged  to  the  Girls'  Friendly  Society  but  dropped  out 
because  the  meetings  ceased  to  interest  her.  She  never  mixed  with  girls 
at  St.  James  Church  because  she  thought  them  two-faced.  She  would  like 
industrial  classes  where  work  with  the  hands  is  done,  but  she  does  not  care 
for  dancing  or  exercise.     Says  she  is  a  good  girl. 

Patient  does  not  want  to  live  away  from  home,  but  realizes  it  is  better 
since  she  worries  too  much  over  her  mother's  suffering.     She  would  want 
to  go  home  every  week. 
HA/C 

December  2. 

Employer,  Mr.  D.  I.  Stern,  Snpt.  of  Sampson  Press,  seen  at  Cambridge 
St.,  Dorchester.  No  exact  record  kept  of  patient,  but  informant  remem- 
bered her  well.  He  had  always  taken  an  interest  in  her  because  he  felt 
that  she  was  delicate  and  that  she  was  not  suited  to  factory  work.  Exact 
dates  of  employment  not  kept.  Informant  thought  she  had  been  there  for 
about  five  or  six  years.  She  was  a  compositor  and  set  up  and  also  cor- 
rected type.  For  the  first  few  years  she  was  in  piece  work  and  may  have 
been  paid  from  $7  to  $17  per  week,  depending  upon  her  speed.  Later  that 
system  was  abolished  and  for  about  a  year  she  was  a  "weekly  worker," 
and  received  $12  per  week.  The  hours  are  from  7  :20  to  5  with  an  hour 
for  luncheon  and  every  Saturday  afternoon  off.  Patient  was  quite  inter- 
mittent in  her  work.  No  record  was  kept  of  that  either.  Patient  worked 
in  a  large,  light,  well-ventilated,  clean  room  with  about  75  other  workers, 
men  and  women.  The  visitor  saw  this  room  and  the  processes  used  by 
the  patient.  There  is  no  heavy  lifting  in  the  work.  The  patient  selected 
type  and  arranged  it  in  "sticks,"  these  in  turn  being  placed  in  a  long  pan. 
After  the  proof  had  been  read  it  was  returned  to  her.  She  then  cor- 
rected_  any  mistakes  in  setting  up  the  type.  Each  worker  sits  on  a  high 
stool  in  front  of  a  slanting  desk  arrangement  on  which  the  type  is  de- 
posited. Theonly  element  of  strain  seemed  to  be  that  of  remaining  seated 
most  of  the  time.  A  fair  degree  of  skill  is  required  in  composition.  The 
worker  must  have  a  good  knowledge  of  the  English  language  and  be  able 
to  spell  and  punctuate  fairly  accurately.  Patient  was  a  fair  worker,  but 
"not  distinguished"  in  speed  or  accuracy.  She  reached  "about  the  middle 
mark"  in  efficiency.  _  The  informant  thought  her  chief  fault  "lack  of  pep 
and  steam."  He  said  she  did  not  seem  to  have  physical  energy.  She  was 
fairly  attentive  to  her  work  and  was  not  "a  gad-about." 

At  the  time  when  the  piece-work  system  was  abandoned  a  great  many 
girls  were  dropped.     In  the  natural  course  of   events  patient  would  also 


640 


APPENDIX    A 


1915 

have  been  dropped  because  she  was  not  particularly  valuable,  but  when  she 
told  him  that  there  was  financial  trouble  at  home  and  that  "it  was  up  to 
her"  he  let  her  stay  on  as  a  weekly  worker.  He  felt  that  the  work  was 
too  great  a  strain  upon  her  and  told  her  that  she  ought  to  get  some  kind 
of  work  in  a  private  family  and  some  place  where  she  could  be  out  of 
doors.  She  looked  anemic.  Informant  heard  that  there  was  one  member 
of  the  family  who  caused  a  lot  of  trouble  and  in  addition  there  was  illness. 
Patient  was  often  out  because  of  sickness. 

She  was  always  quiet  and  tractable,  but  if  anything  annoyed  her  she 
"got  up  and  acted  like  a  normal  person."  Informant  thought  that  she  was 
very  proud  and  that  she  would  take  all  trouble  on  her  own  shoulders  and 
never  give  way  under  it.  At  one  time  she  gave  all  the  financial  assistance 
that  was  given  to  her  family.  Her  eyesight  was  poor  and  she  had  occa- 
sional treatment  for  it.  Patient's  work  showed  no  deterioration.  Patient 
resigned  to  take  another  kind  of  position.  Informant  would  not  care  to 
take  her  back  because  she  was  not  suited  to  the  work,  and  was  not  par- 
ticularly efficient. 

Informant  confirmed  his  own  memory  by  talking  with  Mr.  Quinn, 
patient's  foreman,  who  gave  a  very  similar  report. 

Impression :    Unusually  intelligent  and  understanding  man,  obviously 
interested  in  the  welfare  of  his  employees. 
MBS/C 

December  3. 

Teacher,  Miss  Neide,  seen  at  James  B.  Baker  School,  Roxbury.  She 
did  not  have  patient,  but  had  had  her  l^rother,  Benjamin,  in  her  class.  On 
her  recommendation.  Miss  Neide's  brothers,  "The  Three  Neides,"  took 
Benjamin  to  work  in  their  confectionery  concern.  He  was  there  several 
jears  and  it  was  finally  discovered  that  he  liad  been  taking  supplies  for 
some  time.  He  stole  from  the  safe  the  last  thing.  The  queer  part  was 
that  he  seemed  to  have  no  sense  of  the  wrong  of  it.  They  all  thought  he 
might  be  "not  responsible." 
HA/C 

York  House  Matron,  Miss  Kendall,  who  has  known  patient  about  two 
yearSj  seen.  Patient  has  l^een  to  her,  to  Miss  Hunt,  another  matron,  often. 
She  has  never  had  a  sensible  conversation  with  patient.  She  is  most 
erratic,  talks  at  great  length  aliout  the  men  she  intends  to  marry,  or  about 
injuries  which  various  people  have  done  her.  Nothing  that  she  says  can 
be  relied  upon  for  she  tells  a  different  story  to  everyone.  For  example, 
she  told  Miss  Kendall  not  to  see  her  mother,  because  mother  is  a  Unitarian. 
Mother  was  very  cordial  to  Miss  Kendall.  She  is  very  bold  and  boastful 
about  her  drinking.  Has  said  she  drank  as  much  as  two  quarts  of  port 
wine  in  one  night.  She  usually  drinks  alone.  Has  been  seen  under  the 
influence  of  liquor  though  not  actually  drunk.  She  seldom  takes  anything 
without  immediately  going  to  one  of  the  priests  of  St.  James'  about  it. 

Patient  told  the  story  of  her  father  having  contracted  syphilis  and 
having  died  in  Westboro  State  Hospital.  One  maternal  aunt  was  insane. 
Father  disappeared  at  one  time  for  several  weeks.  When  he  returned  he 
gave  mother  syphilis.  She  soon  found  he  had  a  wife  and  five  children  by 
the  name  of  Farmers,  living  in  the  West  End.  Mother  is  now  suffering 
from  syphilis  and  tuberculosis.  After  death  of  father,  patient  and  brothers 
and  sisters  were  placed  in  home,  patient  going  to  Home  for  Orphan  Chil- 
dren.    Miss  Kendall  has  not  had  the  opportunity  to  verify  these  stories. 

Patient  has  said  a  good  deal  about  having  men  in  her  room  and  Miss 
Kendall  has  thought  her  to  be  immoral.  Karl  Cauldwell  was  a  diseased- 
looking  man;  his  face  was  covered  with  sores. 


APPENDIX    A  641 

In  packing  peanuts,  patient  put  her  name  into  a  package.  In  Septem- 
ber she  had  a  letter  from  a  man  in  Springfield  who  had  bought  the  peanuts. 
She  corresponded  several  weeks  with  him  and  then  told  Miss  Kendall  she 
wanted  to  marry  him.  Associated  Charities  in  Springfield  found  he  was 
about  60  and  had  a  wife  and  children,  and  was  somewhat  "oflf"  on  the_  sub- 
ject of  women.  Patient  saw  this  letter  from  the  Associated  Charities  a 
few  days  before  she  took  poison.  She  had  often  said  before  that  she 
would  do  so,  but  in  an  offhand  way. 

At  home  patient  is  troublesome.     She  stays  out  very  late  several  nights 
a  week  and  is  quarrelsome. 
HA/C 

December  4. 

Guardian,  Miss  George,  of  Public  Schools,  high  school  teacher, 
says  she  was  made  guardian  of  patient  and  other  children  when  father 
died.  She  has  known  the  family  25  years.  When  they  first  came  to  her 
attention  through  the  children  at  school,  they  were  underfed  and  it  was 
found  the  family  had  been  living  on  stale  bread  and  water  for  several  days. 

Patient  has  never  been  a  help  to  her  family  in  a  financial  nor  any 
other  way.  She  should  not  go  home  now  because  she  is  too  great  a  care 
and  worry  to  her  mother  and  sister.  Mother  has  been  sick  all  of  25  years 
Miss  George  has  known  her. 

Patient  graduated  from  grammar  school  at  17.  Was  a  scholar  below 
average. 

HA/C 

December  4. 

Father  Superior  and  Father  Cramer  of  St.  James'  Church  (Episcopal) 
seen.  Patient  has  been  known  to  them  about  two  years,  and  was  at  that 
time  drinking  heavily.  She  has  never  been  seen  when  she  was  unable  to 
walk,  but  oftentimes  was  markedly  under  the  influence  of  liquor  and  very 
unsteady  on  her  feet.  She  has  denied  immoral  sex  conduct  and  they  have 
no  reason  to  believe  she  has  been  immoral.  She  has  a  "diabolical"  and 
malicious  way  of  starting  and  spreading  scandal.  She  will  tell  one  tale  to 
one  person  and  another  to  some  one  else.  Among  the  parishioners,  she  is 
talkative  and  always  ready  to  make  friends.  She  is  not  bold.  The  girls 
of  the  church  will  have  nothing  to  do  with  her  because  of  her  conduct, 
and  have  completely  frozen  her  out.  If  she  came  to  meetings,  they  would 
not. 

The  priests  feel  that  sex  is  the  basis  of  the  whole  matter.  If  she  had 
married  when  younger  she  probably  would  have  been  comparatively  nor- 
mal. At  one  time  last  winter,  Karl  Cauldwell  kept  company  with  her  and 
they  were  engaged.  He  was  an  uninteresting,  somewhat  slow  young  man, 
but  not  objectionable  or  bad.  During  the  time  patient  kept  company,  she 
was  a  normal  individual.  He  soon  discovered  what  she  was  like  and  dis- 
appeared. Patient  has  been  much  worse  since  that,  in  February,  1915. 
Otherwise,  her  conduct  has  not  shown  any  fluctuations. 

Patient  has  taken  her  transfer  letter  from  the  church  so  is  no  longer 
a  member  of  their  parish. 

Impressions :  Father  Cramer  is  a  young  man,  probably  looks  younger 
than  his  years. 

Father  Superior  did  most  of  the  talking  and  gave  general  statements 
chiefly.     Interview  was  in  the  church,  where  the  two  fathers  were  on  duty 
for  hearing  confessions. 
HA/C 


642 


APPENDIX    A 


1915 
December  6. 

Landlady  seen  at  63  Revere  St.  Patient  roomed  there  as  stated  and 
was  recommended  bv  Frank  lUington.  She  had  not  known  patient  drank, 
until  after  patient  had  gone  and  Mr.  IlHngton  returned.  He  mentioned  it 
and  she  then  remembered  smelling  liquor  on  patient's  breath  once.  In 
the  beginning  she  was  friendly  with  some  church  girls,  but  later  had  a 
falling  out  and  asked  landlady  not  to  let  them  go  to  her  room.  Patient 
never  made  friends  with  other  lodgers.  "There  are  twelve  rooms,  two  or 
three  let  to  middle-aged  men,  and  most  rooms  let  for  many  years  to  same 
persons."  Landlady  never  heard  of  her  going  out  with  men  nor  did  she 
observe  her  coming  home  with  any.  She  never  had  any  in  her  room. 
Patient  was  out  after  twelve  some  nights  when  she  went  home  and  also 
she  always  went  home  on  Saturday  for  Sunday.  Other  nights  patient 
stayed  home  and  sewed.     She  does  this  well. 

Patient  was  a  good  lodger  and  always  paid  her  rent  ($2  a  week) 
promptly  and  made  no  trouble.  Landlady  would  not  take  her  back  now 
she  knows  she  drinks.  She  had  thought  her  queer  because  she  talked  so 
much,  mostly  about  her  disagreements  with  church  people. 

Landlady  and  her  husband,  old  people,  have  lived  in  this  place  for 
years  and  have  good  old  furniture  and  china  and  very  homelike  rooms  of 
their  own. 

Impression:  Unusually  honest,  frank,  and  dependable  old  lady.  A 
well  run,  respectable  house. 

December  6.  ^^ 

Employer,  Mr.  Ra-vson,  Mgr.  T.  S.  Davis  &  Co.,  "Money  to  Loan,' 
seen  at  his  office,  180  Young  St.,  Boston.  Says  he  was  there  when  patient 
was  there  for  about  six  months  in  1904.  She  did  sirnple  clerical  work  and 
some  bookkeeping  and  informant  can  remember  nothing  except  that  patient 
was  satisfactory  and  left  for  better  wages  in  a  laundry. 

Impression:   A  middle-aged  man  of  refined  appearance  and  manner. 

December  6. 

Employer,  Miss  Ingham,  in  charge  of  packing  room  at  G.  L  Evans  & 
Co.,  "Utopian  Chocolates,"  seen  at  98  Vernon  St.,  Boston.  She  says  pa- 
tient worked  under  her  several  months,  from  September,  1914.  through  the 
Christmas  rush  season,  and  was  entirely  satisfactory,  always  on  hand 
promptly.  Informant  knew  patient  was  a  church  memljer  and  other  women 
working  there  also  lived  near  patient  in  South  End  and  went  to  St.  James. 
The  women  here  arc  all  Americans.  Patient  might  be  reemployed  after 
the  rush  season,  but  informant  thinks  it  would  not  be  wise  for  patient  to 
work  there  during  the  rush.  Patient  wrot«  to  informant _  several  times 
since  leaving,  but  informant  has  not  answered  or  seen  patient.  _ 

Impression :  Young,  but  mature  American  woman,  refined  in  appear- 
ance, manner,  and  speech,  well  dressed  and  of  vigorous  build. 

Factory :  Only  the  office  seen.  This  was  very  neat  and  there  were  two 
other  women  of  refined  appearance. 

December  6. 

Employer,  Mr.  L  S.  Henderson,  Supt.,  Tyson  Brand  Co.,  salted  nuts, 
etc.,  seen  at  the  factory.  Cross  St.,  Cambridge.  He  says  patient  was  one 
of  the  first  to  apply  on  opening  of  new  factory  last  February.  She  \vas 
entirely  satisfactory  and  was  especially  prompt  at  work.  She  did  packing 
at  a  bench  with  Americans  though  there  are  some  Italians.  She  earned 
$5.50  per  week  and  might  have  had  piece  work  if  she  had  stayed  and 
earned  as  much  as  $7.00  a  week.  He  noticed  particularly  that  she  took  no 
notice  of  the  men  about  the  factory  as  many  women  do.  He  would  re- 
employ patient  at  any  time. 


APPENDIX    A  643 

1915 

Impression :   A  young  man  of  refined  appearance  and  manners. 

Factory :    A  new  brick  building,  very  well  lighted,  in  neighborhood  of 
other  factories. 
AEL/C 

December  7. 

Sister  Florence  seen,  in  town  after  work  by  appointment.  Patient's 
conduct  has  been  the  greatest  trial  to  sister  and  mother.  She  talks  so  fast 
and  so  much  it  makes  her  mother  nervous.  She  is  superior  and  will  never 
take  any  advice  from  them.  Her  connection  with  a  different  church  is 
partly  responsible  because  she  has  acted  independently  in  this  respect.  She 
thinks  she  can  in  all  others.     She  is  stubborn. 

Sister  believes  she  drank  a  good  deal  with  people  whom  she  visited 
in  South  End. 

Patient  had  a  better  chance  than  any  of  other  children.  She  was  the 
only  one  who  graduated  from  grammar  school.  She  was  not  petted  and 
spoiled  because  she  was  the  youngest.  In  money  matters  she  is  brighter 
than  her  sister,  being  quicker  to  add  up  her  figures  to  get  results. 

Sister  has  worked  years  for  Miss  Nancy  Stowell.  Her  physical  health 
is  not  as  good  as  patient's. 

Impression  :   Open-minded,  practical,  and  thoroughly  sympathetic.    She 
is  a  young  woman  of  small  stature  and  a  somewhat  nervous  manner. 
HA/C 

December  8. 

Family's  minister,  Mr.  Young,  Channing  Church,  seen.  He  says  that 
the  family  feel  that  patient  has  gained  nothing  through  her  connection 
with  St.  James  Church,  and  that  it  would  be  better  if  she  discontinues 
going  there  any  more.  No  matter  what  there  was  to  be  done  at  home, 
or  how  sick  her  mother  was,  patient  always  dropped  everything  to  attend 
services.     She  was  told  that  she  must  go  every  week. 

The  remainder  of  the  Paris  green  was  found  in  patient's  trunk.  She 
has  very  few  clothes. 

Sister  Florence  works  for  Nancy  Stowell,  dressmaker,  on  Charles  St. 
Miss  Stowell  is  very  good  about  calling  sister  to  the  telephone. 

Impression:    Reliable,  earnest  man  of  about  35  years  of  age. 
HA/C 

December  17. 

School  report  received. 
HA/C 

December  2;^. 

Dixon's  Commercial  School  reports  no  record  of  patient. 
HA/C 

1916 
January  21. 

State  Board  of  Insanity  telephoned  to.     They  have  no  record  of  father, 
James  Farmer. 
MPC/C 

January  21. 

Patient's  mother  seen  at  home.  Says  that  patient  has  always  had  her 
own  way  ever  since  she  was  a  child;  that  she  has  had  more  opportunities 
and  used  them  less  than  any  other  member  of  the  family.  Patient  is  only 
member  of  the  family  who  went  through  the  Grammar  School.  Patient 
was  very  ill  during  the  voyage  from  England  and  has  never  been  strong 
since,  although  she  was  a  very  healthy  baby.  Informant's  husband,  from 
whom  she  was  separated,  has  been  dead  for  12  years.     They  have  always 


644  APPENDIX    A 

1916 

had  all  they  could  do  to  get  along.  Patient  always  told  people  that  she 
"slaved"  at  housework,  l3Ut  informant  says  that  she  never  did  any  at  all, 
not  even  to  helping  with  the  coal  for  the  fire,  etc.  As  informant  has  for 
many  years  been  a  cripple  (six  operations,  one  knee  removed)  she  has  not 
been  able  to  do  heavy  work. 

Five  years  ago  they  had  to  give  up  their  home  for  a  time  during 
operation  on  informant's  legs.  The  same  thing  has  occurred  a  number  of 
times  since,  the  last  time  about  a  year  ago.  At  one  time  when  informant 
was  "flat  on  her  back"  patient  locked  the  door,  went  out  saying  that  she 
would  kill  herself.  Instead  she  went  to  her  brother's,  where  she  stayed 
for  two  weeks.  At  another  time  a  year  ago  last  October  she  and  her  sister 
went  to  look  for  a  flat.  Informant  thought  that  she  was  able  to  have  her 
own  home  again  and  that  patient  would  live  with  them  again.  While  they 
were  out  patient  told  her  sister  that  she  would  never  live  with  her  family 
again.  Patient  and  her  sister  never  got  along  together.  Informant  blames 
patient  who  always  expected  her  sister  to  do  everything  for  her  and  who 
never  did  anything  in  return.     Patient's  brother  never  liked  her. 

While  patient  was  living  away  from  home  she  used  to  bring  her  wash- 
ing home  for  her  mother  to  do.  She  never  did  it  herself.  Informant  says 
that  her  clothes  were  always  in  a  disgracefully  dirty  condition ;  that  it  was 
too  hard  work  for  her  to  do  again.  Informant  says  that  patient  always 
talks  a  lot  about  being  fond  of  her,  but  she  does  not  show  it  much  in  her 
actions.  Says  that  patient  talks  too  much  anyway.  She  used  to  make  up 
stories  about  unkind  things  informant's  friends  said  to  her. 

Informant  thinks  that  Father  Cramer  allowed  patient  too  much  free- 
dom;  that  if  he  had  been  more  strict  with  her  she  would  not  have  done  so 
many  foolish  things.  Informant  says  that  patient  got  in  with  a  poor  lot 
of  girls  at  St.  James  Church. 

Informant  says  that  when  patient  came  home  to  live  with  them,  as  she 
did  for  a  while,  she  spends  all  Sunday  morning  in  bed,  leaves  the  room 
where  she  sleeps  (the  "front"  room)  in  an  untidy  state,  and  does  not  help 
with  any  of  the  work.  Patient's  sister  gives  $5  per  week  to  informant 
who  pays  $3  for  rent  and  makes  the  rest  do.  Patient's  sister  makes  all 
her  own  clothes  and  in  the  past  has  made  many  of  patient's.  Patient 
thinks  that  she  ought  to  make  hers  all  the  time. 

Patient  went  out  at  all  hours  even  when  she  lived  at  home  and  never 
told  her  family  where  she  was  going.  They  never  knew  where  she  spent 
her  time  unless  she  happened  to  mention  it  rather  casually. 

Impression :  A  very  delicate  old  lady  who  cannot  walk  without 
crutches  and  then  with  great  difficulty.  She  seems  to  be  quite  passive  as 
though  completely  worn  out  with  the  whole  situation  with  which  she 
obviously  feels  unable  to  cope.  She  appeared  convincing  and  aroused  con- 
siderable sympathy. 
HA/C 

January  22. 

J'ttal  Statistics  OiHce  gives  following  record  of  father:    Died  Novem- 
ber 5,  1904,  at  Westboro  State  Hospital.     Cause,  General  Paralysis.     Resi- 
dent of  Boston,  age  46.     Inmate  i  year  and  2  months  at  Westboro  State 
Hospital. 
FJC/C 

January  27. 

Children's  Home  Society  telephoned  to.  Patient  and  family  are  not 
known  to  them  as  was  stated  by  sister  in  medical  history  in  house  record. 


APPENDIX    A  645 

1916 

March  27. 

Mother  seen.  During  the  time  that  the  patient  lived  at  home,  from 
June,  1915,  until  admission  to  the  hospital,  she  paid  in  her  $5  wages  to  her 
mother.  ]\Iother  gave  her  $1  for  spending  money,  used  $3  and  put  aside 
$1  for  patient's  clothes.  Patient  later  found  out  that  her  mother  had  saved 
$8  and  was  very  disagreeable  about  it.  She  asked  for  it  several  times  and 
said  she  saw  no  reason  why  she  could  not  take  care  of  her  own  money, 
so  that  mother  gave  it  to  her.  She  did  not  tell  the  family  that  she  had  any 
money  saved.  They  all  went  to  Nashua,  N.  H.,  to  visit  during  patient's 
and  her  sister's  two  weeks'  vacation  and  patient's  sister-in-law  found  patient 
very  difficult  to  deal  with.  She  was  disagreeable  and  lazy  and  impudent. 
While  there  she  wrote  often  to  the  old  man,  Mr.  Radnor,  with  whom  she 
used  to  play  cards  about  every  week  when  she  lived  in  the  West  End.  She 
also  wrote  long  letters  to  Father  Cramer. 

At  one  time  patient  was  a  member  of  the  Girls'  Friendly  Society,  but 
she  had  a  quarrel  with  the  leader  (Christ  Church,  East  Boston)  and  gave 
it  up.     Patient  is  apt  to  like  people  very  well  and  talk  about  them  all  the 
time  for  a  short  time  and  later  turn  against  them. 
HA/C 

Sister  Edith  seen  by  House  Historian.  See  medical  record  for  history. 
HA/C 


ACTION  TAKEN 
December  2. 

Employer,  Sampson  Press,  would  not  be  willing  to  take  patient  back 
as  he  considers  her  unfit  for  factory  work. 

MBS/C 

December  3. 

Miss  Kendall,  York  House,  is  willing  to  take  patient  into  the  Gales  St. 
House  to  live  until  she  can  find  work.  She  feels  that  St.  James  Church 
people  should  not  let  their  responsibility  end  here.  Though  it  seems  best 
for  patient  to  drop  her  connection  with  that  church,  they  ought  to  stand 
expense  of  sending  her  away,  if  necessary. 
HA/C 

December  4. 

Miss  Kendall  says  there  is   room  at  the  Roxbury  House,  if  patient 
should  decide  to  go  there  for  six  months.     It  would  probably  be  the  best 
plan. 
HA/C 

December  6. 

Family's  minister,  Mr.  Young  of  Channing  Church  (Unitarian),  tele- 
phones. He  has  expected  to  take  up  the  care  of  patient  when  she  leaves. 
The  family  (mother  and  sister)  are  unwilling  that  patient  should  go  to 
York  House.  They  are  anxious  to  have  her  sever  connections  with  the 
Episcopal  Church  for  reasons  which  Mr.  Young  cannot  give  by  telephone. 
His  plan  is  to  place  patient  at  the  Gordon  House  of  Working  Girls.  While 
she  works  in  the  day  time,  she  should  have  some  training  business  course 
at  Y.  W.  C.  A.  at  night  as  well  as  club  or  class  work  one  or  two  evenings. 
He  knows  several  workers  at  this  house,  whom  he  will  interest  in  patient. 
He  would  like  visitor  to  keep  in  touch  with  patient  also. 

Mr.  Young  feels  that  institutional  restraint  of  such  a  girl  who  has  been 
allowed  so  much  freedom,  will  only  make  her  rebellious  and  produce  no 
results. 
HA/C 


646 


APPENDIX    A 


191S 
December  7. 

Family's  minister,  Mr.  Young,  telephones  that  he  will  be  able  to  ar- 
range for  patient  to  live  at  Gordon  House,  44  Dix  St. 
HA/C 

Mr.  Young  seen.  He  has  been  talking  with  Mrs.  Dickinson,  head  of 
the  House,  and  she  will  take  an  interest  in  patient.  Miss  Taylor  of  Canter- 
bury Church  will  do  what  she  can  for  her  and  take  a  friendly  interest  in 
her.  Neither  one  of  these  people  will  be  able  to  take  definite  and  com- 
plete supervision  of  patient,  and  Mr.  Young  feels  that  he  will  not  be  able 
to  do  so  himself. 

He  will,  however,  see  the  patient  frequently  and  will  naturally  get  the 
point  of  view  of  the  family  because  he  sees  them  often.  He  will  be  able 
to  report  to  visitor  anything  which  arises  in  patient's  situation.  He  will 
pay  for  patient's  board  ten  days  or  two  weeks,  but  feels  that  she  should 
have  work  by  that  time.  He  hopes  that  a  definite  schedule  can  be  arranged 
for  patient,  so  that  she  will  have  each  evening  planned  for.  He  would 
suggest  her  taking  some  training,  such  as  secretarial,  at  an  evening  school. 

He  would  be  glad  to  get  some  clothes  for  her  so  that  she  will  not  be 
ashamed  when  meeting  the  other  girls  at  the  House. 

Patient  taken  to  Gordon  House  and  Mrs.  Dickinson  seen.     Patient  will 
go  to-morrow  morning  to  the  Massachusetts  General  Hospital,  Out- Patient 
Department,  Female  Medical  Clinic,  for  a  thorough  examination.     There 
is  a  question  of  anemia  and  tuberculosis. 
HA/C 

December  10. 

Patient  writes.     She  returns  to  Massachusetts  General   Hospital   for 
examination  to-day.    Girls  at  Gordon  House  are  not  allowed  out  over  night. 
See  letter. 
HA/C 

December  11. 

Massachusetts  General  Hospital,  Social  Sen-ice,  Miss  Davis,  telephones 
that  patient's  lungs  are  negative,  but  that  she  has  a  severe  anemia.  Dr. 
Dawson  advises  patient  going  into  the  House  for  a  few  days.  Patient  is 
reluctant  to  do  this  as  she  says  she  is  devoted  to  her  roommate  and  does 
not  want  to  leave  her.  Sister  is  at  Out-Patient  Department  with  patient 
and  she  saj-s  patient  will  stay. 

Case  will  be  transferred  to  House  Social  Service  so  that  visitor  may 
have  reports  directly. 

Patient  and  sister  telephoned.     Patient  did  not  want  to  enter  hospital 
to-day  and  Dr.  Young  says  he  is  not  sure  of  a  bed  for  Monday  ,12/13. 
Patient  promises  to  go  to  Miss  Davis  on  that  date  and  enter  hospital  if 
possible.     First  asked  to  be  treated  by  private  physician. 
HA/C 

December  13. 

Patient  writes.     See  letter. 
HA/C 

December  14. 

Massachusetts  General  Hospital,  Miss  Davis,  telephoned  to.  Patient 
was  admitted  yesterday. 

Minister,  Mr.   Young,  and  Mrs.  Dickinson  telephoned  to.    Arranged 
for  patient  to  return  to  Gordon  House  on  her  discharge  from  Massachu- 
setts General  Hospital. 
HA/C 


APPENDIX    A  647 

1915 
December  17. 

Sister  Florence  seen  in  town  by  appointment.  Patient  is  being  dis- 
charged to-day  and  she  will  take  her  to  Gordon  House.  Sister  does  not 
favor  any  domestic  training  for  she  thinks  patient's  place  is  at  home  if  she 
can  behave  properly.  For  some  time  she  has  talked  of  stenography,  but 
when  aunt  took  a  book  to  her  she  did  not  follow  up  the  work  by  herself. 

They  like  to  have  patient  at  home  Sundays.     She  makes  mother  nerv- 
ous because  she  talks  so  fast  and  so  much,  but  they  are  both   fond  of 
patient  and  ready  to  do  all  they  can  to  help  her. 
HA/C 

December  18. 

Massachusetts  General  Hospital,  Social  Service,  telephones  that  patient 
is  not  anemic  and  can  go  to  work.     She  needs  no  diet. 

Patient  seen  at  hospital.  Is  always  able  to  find  work  for  herself. 
Miss  Taylor,  Canterbury  Church,  saw  her  at  Massachusetts  General  Hos- 
pital and  said  she  might  be  able  to  get  her  into  a  private  printing  place. 
Patient  wants  to  follow  her  printing  trade,  as  she  is  used  to  it. 

Patient  intends  to  go  home  only  a  half  day  Sundays  because  the  atti- 
tude at  home  wears  on  her.  Her  mother  continually  gives  her  good  advice 
and  harps  on  the  past.  They  are  "too  strict."  She  cannot  take  off  her 
dress  and  put  on  a  kimono  to  rest  until  it  is  time  to  go  to  bed.  She 
cannot  have  company  because  it  wears  on  her  mother.  They  are  con- 
tinually suspicious  of  her  conduct. 

Last  night  she  stayed  at  home  because  she  went  out  to  get  her  things. 
They  would  not  let  her  sleep  on  the  cot  in  the  parlor  where  she  used  to 
sleep,  but  had  to  share  her  mother's  bed,  so  that  all  three  were  in  the  same 
room.  Patient  said  nothing  and  does  not  know  the  reason  for  this  except 
that  they  may  not  have  trusted  her  to  be  alone. 

At  Gordon  House,  patient  likes  her  roommate  ever  so  much  and  her 
room  too. 

Sent  patient  to  Harvard  Dental  School  to  have  teeth  examined.     She 
will  look  for  work  Monday. 
HA/C 

December  23. 

Patient  writes.     See  letter  and  Christmas  card. 

Patient  telephones.  Hopes  to  get  work  in  Newman's,  465  Denver  St., 
at  typesetting.  Wages  $12  a  week.  There  is  no  vacancy  now,  but  she  is 
promised  the  next  opportunity. 

She  will  go  to  her  own  dentist.  Dr.  Day,  Davis  Square,  Dorchester, 
who  used  to  do  work  half  price,  since  the  Dental   School  is  closed  for 
vacation. 
HA/C 

December  27. 

Patient  telephones.  She  goes  to  work  to-morrow  at  piece  work  in 
Dalton  Fastener  Co.,  42  Belle  Ave.,  Cambridge  (near  Kendall  Square). 
Her  first  week's  wages  will  have  to  go  to  the  Mercantile  Agency.  Girls 
earn  from  $6-$i2,  according  to  their  ability  and  skill.  Hours  are  7:30-5  ^30 
and  patient  can  have  her  breakfast  at  Gordon  House  and  take  her  lunch. 

Patient  says  she  had  a  happier  Christmas  than  for  some  time.     "We 
never  had   happiness   in  the   home  before."     She   stayed   all   night   there. 
Patient  tells  of  going  to  Beacon  Hill  Christmas  Eve  to  hear  the  carols. 
She  went  to  Charles  St.  Jail- and  was  much,  interested  in  that. 
HA/C 


648 


APPENDIX    A 


1915 

December  31. 

Patient  vurites.     See  letter. 
HA/C 

1916 

January  10  to  January  17. 

Patient  writes.    Asks  to  be  allowed  to  go  home  Saturdays  for  over 
night.     She  writes  she  has  joined  the  Unitarian  Church.     See  letters. 
HA/C 

January  17. 

Patient  sends  diet  for  past  week  by  request. 
HA/C 


Monday : 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Wheatena 

Thin  egg  sandwich 

Cold    sliced    ham 

Cocoa 

Salt  fish  hash 

Sponge   cake 

Boiled  cabbage 

Apples 

Cup  of  coffee 

Blueberry   cake 

Boiled    carrots 

Oat.   cr. 

Apple 

Mashed  potatoes 

Beef   tea 

Uneedas 

Tuesday: 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Oatmeal 

Ham   sandwich 

Boiled      cod      and 

Cocoa 

Fried    eggs 

Doughnut 

cream    sauce 

Oxtail    soup 

Mashed   potatoes 

Apple 

Boiled    onions 

Uneedas 

Coffee 

Boiled    potatoes 
Apple   tapioca 

Wednesday : 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Wheatena 

Deviled  ham  sand- 

Roast  beef 

Cocoa 

Slice  of  salt 

wich 

Boiled   lima   beans 

Oat.   cr. 

chipped   beef 

Half    slice    cake 

Carrots 

Uneedas 

(tissue) 

Apple 

Boiled    potatoes 

Beef  tea 

Baked   potatoes 

Chocolate    blanc 

Raised    biscuit 

mange 

Coffee 

Thursday: 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Corn    meal 

Roast    beef    sand- 

Beef  stew 

Cocoa 

Salt  fish 

wich 

Cream   pie 

Oat.   cr. 

Fried    potatoes 

Half    slice    cake 

Bread  and  butter 

Uneedas 

Raised    biscuit 

I    cookie 

Beef  tea 

Coffee 

Cocoa 
Apple 

Apples 

Friday : 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Wheatena 

Meat  pie 

Fried  fish 

Cocoa 

3    slices    bacon 

Tea 

Mashed    potatoes 

Oat.   cr. 

2  baked   potatoes 

Corn 

Uneedas 

Coffee 

Bread  pudding 

Beef   tea 
Apples 
Wash,   pie 

Saturday: 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Hash 

Sliced   ham 

Baked  beans 

Cocoa 

Muffin 

Baked   potatoes 

Piccalilli 

Oat.    cr. 

Coffee 

Tea 

Bread  and  butter 
Tea 

Uneedas 
Beef   tea 
Macaroons 

Sunday: 

BREAKFAST 

LUNCH 

DINNER 

EVENING 

LUNCH 

Fish    cakes 

Tea 

Canned    cherries 

Cocoa 

Beans 

Roast  stuffed  pork 

Bread  and  butter 

Beef   tea 

Brown    bread 

Pickles 

Cake 

Oat.    cr. 

Coffee 

Bread  and  butter 

Cocoa 

Uneedas 

Potatoes 

Frankfurters     and 

Squash    pie 

bread 
Orange 

$1.37  was  spent  extra  for  food. 
HA/C 


APPENDIX   A  649 

1916 
January  18. 

Mrs.  Dickinson,  Gordon  House,  telephoned  to.  She  says  patient  is 
doing  well.  She  takes  an  interest  in  the  life  at  the  House,  enjoys  the  other 
girls,  and  has  given  no  trouble  in  any  way. 

Mrs.   Dickinson  would   be   willing   for  her  to   go  home   Saturday  if 
visitor  arranges  it. 
HA/C 

January  19. 

Patient  seen  at  hospital.  Reported  at  evening  clinic  to  Dr.  Hatch. 
She  is  happy  and  says  she  is  doing  her  best.     Drinking  she  never  thinks  of. 

The  life  at  the  House  is  great  fun.  The  girls  always  come  into 
patient's  room  toward  the  end  of  the  evening  and  leave  things  to  eat, 
apples,  cocoa.  Patient  spends  her  evenings  sewing.  She  mends  her  room- 
mate's clothes  as  well  as  her  own  and  she  has  been  doing  some  crocheting 
and  embroidery  for  the  nurse  of  the  House,  who  is  engaged.  Mr.  Young's 
church  is  to  have  a  Fair,  and  she  is  making  things  for  that  as  a  surprise. 
She  seldom  goes  out  evenings  though  she  went  once  to  moving  pictures. 
Sundays  she  goes  home  in  the  morning  and  returns  in  the  afternoon.  She 
washes  her  own  shirtwaists  at  home,  but  her  other  clothes  are  done  at  the 
House  and  included  in  the  board.  Patient  and  her  mother  are  devoted  to 
one  another  and  get  on  peaceably.  Sister  treats  her  better  now,  but  patient 
has  no  fondness  for  her.  Patient  took  her  roommate,  Fannie,  home  with 
her  last  Sunday  and  the  family  liked  her. 

Patient  walks  to  and  from  work  to  Kendall  Sq.,  Cambridge.  She 
sleeps  with  windows  open  and  eats  heartily. 

Work  has  been  irregular.  The  largest  wage  made  was  some  over 
$7,  but  it  has  been  nearer  $5  usually.  There  are  many  types  of  work  and 
different  machines  and  patient  will  make  an  effort  to  get  on  a  machine 
with  which  she  can  earn  most. 

The  foreman,  Mr.  James,  is  good  to  her,  and  when  she  complained  he 
shifted  her.  This  week,  work  has  been  slack  because  the  firm  is  starting 
a  new  department  next  week.  The  old  girls  say  one  is  seldom  laid  off,  so 
patient  will  try  it  out  another  week.  She  can  earn  80  cents  for  the  other 
days  this  week.  The  board  at  Gordon  House  is  $4.  Patient  owes  Mr. 
Young  $4  and  the  House  $2  from  a  week  she  was  not  working  (Mr. 
Young  only  paid  the  first  two  weeks).  Patient  has  plenty  of  clothes. 
Mr.  Young  offered  her  more,  but  she  did  not  need  them.  She  still  has 
some  savings,  but  she  does  not  wish  to  spend  them  for  current  expenses. 

Patient  is  anxious  to  learn  linotype  because  that  was  what  put  her  out 
of  work  at  the  Sampson  Press  when  she  was  setting  type  by  hand.  She 
thinks  she  cannot  afford  to  go  to  a  school  for  it  this  year. 

Patient  tells  of  a  young  man,  whom  she  passes  every  morning  going 
to  work,  asking  her  to  meet  him  some  night.  She  used  to  pass  him  when 
she  worked  at  Tyson  Brand  and  so  she  speaks  to  him.  She  does  not 
intend  to  go  out  with  him.  Recently,  she  met  Karl  Cauldwell  and  he 
walked  home  with  her.  He  offered  to  "keep  company"  with  her  again,  but 
she  "threw  him  over." 

Patient  seems  happy,  looks  well,  and  is  very  friendly  toward  visitor. 
HA/C 

January  21. 

Minister,  Mr.  Young,  telephoned  to.     He  thinks  patient  is  doing  well 
and  has  not  been  drinking.     She  is  not  really  self-supporting  yet.     He  was 
surprised  and  pleased  to  have  her  join  the  church. 
HA/C 


650  APPENDIX   A 

1916 

January  21 

Patient's  mother  seen  at  home.  Informant  thinks  that  patient  gets 
along  with  sister  somewhat  better  than  previously,  but  notices  no  other 
change  in  her  actions  or  attitude.  Visitor  asked  informant  about  having 
patient  return  to  her  home  to  spend  Saturday  nights.  Informant  is  willing 
to  have  her,  but  seems  to  feel  that  it  may  not  be  for  patient's  best  good, 
as  she  thinks  that  patient  is  making  the  necessity  of  being  at  home  in  order 
to  go  to  church  an  excuse  to  escape  the  early  rising  necessary  at 
Gordon  House.  Informant  says  that  patient  can  get  to  Church  Sunday 
morning  from  where  she  is,  that  she  did  it  last  Sunday  with  her  room- 
mate whom  she  took  to  dinner  at  her  home.  Informant  says  that  on  day 
patient  wrote  to  previous  visitor  (i/i)  she  spent  the  night  at  home  and 
did  not  go  to  church  the  next  morning,  but  read  in  bed.  Informant  thinks 
that  patient  will  impose  upon  previous  visitor  unless  she  is  most  careful. 
Informant  fears  that  patient  will  be  most  disagreeable  to  her  if  she  finds 
out  what  informant  has  said.  Informant  is  so  tired  of  having  fusses  that 
she  does  not  give  a  word  of  advice  to  patient  now — whenever  she  does 
patient  is  ugly  to  her. 

Informant  suggests  that  if  it  is  decided  to  be  wise  for  patient  to  go 
home  Saturday  nights,  it  would  be  advisable  to  make  it  conditioned  upon 
her  attending  church  Sunday  mornings,  and  in  order  not  to  make  the 
patient  angry  at  her  family,  to  have  the  information  obtained  from  Mr. 
Young,  the  minister.  Informant  says  that  patient  cannot  fool  him.  Patient 
joined  the  Unitarian  Church  the  first  Sunday  of  January,  for  which  her 
mother  is  glad.  Thinks  it  may  do  something  toward  keeping  her  with  the 
family. 

Informant  says  that  patient  .should  live  as  she  is  now  with  people  and 
under  rule ;  that  otherwise  she  will  become  untidy  again  and  will  bring  bad 
girls  into  her  room.  She  thinks  that  if  patient  complains  to  visitor  about 
conditions  as  she  has  at  home  that  visitor  should  not  pay  too  much  atten- 
tion to  her,  but  should  insist  that  she  live  with  a  roommate. 

Informant  says  that  patient  was  doing  fairly  well  until  last  week  when 
she  made  only  $5  l)ecause  the  machine  broke  down  and  there  was  not 
enough  work  to  do.  Says  that  patient  was  discouraged  Sunday.  In- 
formant thinks  patient  should  try  to  get  a  position  as  monotype  corrector 
as  that  is  her  trade. 

Patient  has  never  contributed  to  support  of  family,  and  does  not  con- 
sider the  extra  trouble  it  makes  when  she  visits  them,  either  in  the  matter 
of  expense  or  work. 

Informant  is  evidently  rather  afraid  of  patient  and  anxious  not  to 
displease  her. 
MBS 

January  21. 

Patient  and  mother  written  that  she  is  not  to  go  home  Saturdays  for 
the  present. 
HA/C 

January  24. 

Patient  writes.     See  letter. 

Patient  telephones  she  is  out  of  work  for  a  day  or  so.  Will  go  to 
Harvard  Dental  School  this  morning. 

Linotype  School  sends  literature.     Evening  course  $50. 

Patient  seen  at  hospital.  Is  to  go  back  to  work  1/26  and  to-morrow 
will  have  more  work  done  on  her  teeth  and  will  spend  extra  time  mending. 


APPENDIX    A  651 

1916 

She  made  $4.40  last  week  and  the  foreman  has  promised  to  put  her 
on  a  good  machine  when  she  goes  back.  She  likes  it  so  well  there  that 
she  hates  to  leave  and  will  give  the  place  further  trial.  Mr.  James  urged 
her  to  stay  on. 

Patient  wants  to  go  home  Saturday  nights  because  it  means  such  an 
early  rising  and  such  a  hurry  to  get  out  to  Roxbury  in  time  for  church 
Sundays.  She  stayed  at  home  Friday  night  because  she  and  sister  went  to 
an  entertainment  at  Church. 

Patient  is  very  friendly  indeed  and  assures  visitor  she  wants  to  make 
as  little  trouble  as  possible. 

Patient  wants  to  go  to  Linotype  School  when  she  gets  well  established 
in  work. 

January  25. 

Patient  writes  and  asks  to  be  allowed  to  help  and  do  some  sewing  for 
visitor.     See  letter. 

Patient  written    to,  asking   her   to   make   two    chemises    for   another 
patient. 
HA/C 

February  9. 

Patient  zvrites,  1/26  and  29,  2/5  and  9,  and  telephones  2/5.  She  is  en- 
thusiastic about  her  work,  to  which  she  went  back  1/27.  She  made  $1.75 
and  $1.80  for  the  first  two  days  and  over  $7  for  the  past  week.  _  She 
expects  to  have  all  back  board  paid  by  2/20.  She  has  some  neuralgia  of 
the  gums  and  if  it  is  not  improved  in  a  few  days,  she  will  take  time  off 
to  have  her  teeth  seen  to.  Her  roommate,  Fannie,  has  been  very  sick  and 
patient  had  to  wait  on  her.     Now  she  is  away  for  a  few  weeks'  rest. 

February  9. 

Patient  writes,  "It  may  seem  strange  to  many  people  that  my  mother's 
illness  should  make  such  an  impression  on  me,  but  it  does.  I  am  the 
youngest  and  think  a  whole  lot  of  my  mother,  but  instead  of  going  out 
and  seeing  her  enjoy  life,  I  have  to  see  her  a  cripple  holding  back  her  pain 
and  trying  to  be  happy.  ...  I  am  sorry  I  was  so  bad,  but  I  will  be  good 
always  now  to  make  up  for  it." 

See  letters. 
HA/C 

February  9. 

Matron  of  Gordon  House,  Mrs.  Dickinson,  seen.  She  likes  patient 
and  thinks  she  is  doing  her  very  best.  No  indications  that  she  has  been 
drinking.  The  other  girls  like  her,  as  she  is  always  bright  and  jolly. 
Informant  thinks  she  is  happy  there.  She  has  a  very  lovely  roommate,  a 
blind  girl,  to  whom  she  is  devoted,  and  at  present  she  is  feeling  pretty 
lonely,  as  the  roommate  has  gone  away  to  the  country  for  two  weeks. 
Informant  chose  this  girl  for  patient's  roommate,  as  she  felt  she  would  be 
a  good  influence. 

Patient  is  orderly  about  picking  up  her  things  but  the  room  is  apt  to 
be  in  need  of  dusting,  but  informant  makes  allowances  for  this  as  patient 
has  to  go  off  so  early  to  work.  Leaves  the  house  at  seven  and  does  not 
come  back  till  almost  six. 

The  factory  where  she  works  is  being  enlarged  and  temporarily  a 
good  many  people  are  working  only  part  time.  Last  week  patient  worked 
only  a  few  days  and  did  not  earn  enough  to  pay  her  board.  When  she 
works  full  time  she  makes  only  about  $8  at  piece  work.     She  is  somewhat 


652  APPENDIX    A 

1916 

discouraged,  and  very  restless  when  out  of  work.  Talks  of  changing  to 
Gillette  Razor  Factory,  but  Mrs.  Dickinson  is  urging  hei  to  stick  it  out 
here  in  hopes  that  she  will  soon  have  regular  full-time  employment. 

Informant  feels  she  is  devoted  to  her  mother,  but  cannot  get  on  well 
with  her  sister.  Has  told  informant  that  she  never  could  live  with  her. 
Informant  thinks  that  probably  patient  teases  sister,  who  retaliates. 

There  are  no  clubs  or  classes  in  Gordon  House  to  which  she  can 
belong.  There  is  a  Friday  Night  Forum  to  discuss  social  questions,  but 
patient  has  not  attended.  She  does  not  go  out  evenings  to  movies,  only 
occasionally  for  a  few  minutes  to  do  an  errand.  Does  not  go  with  any 
former  friends,  but  seems  contented  to  be  with  her  roommate,  and  sews 
a  good  deal. 
EB/C  ■• 

February  12. 

Patient  seen  at  hospital.  Brought  visitor  a  guest  towel  and  face  cloth 
which  she  had  made  as  a  present.  Last  week  made  $8  and  was  idle  part 
of  two  half  days.  She  would  have  made  more,  but  was  slow  on  account 
of  a  small  injury  to  the  tip  of  a  finger. 

Patient  is  lonely  with  roommate  away. 
HA/C 

February  15. 

Patient  writes.  Is  going  to  a  suffrage  meeting  with  sister  and  a  friend 
to-night.     See  letter. 

February  21. 

Patient  and  sister  sent  theater  tickets  to  "It  Pays  to  Advertise"  to- 
night. 
HA/C 

March  9. 

Patient  writes  often.     See  letters. 
HA/C 

March  10. 

Patient  seen  at  hospital.  This  week  has  been  a  bad  one  at  work. 
They  were  laid  off  more  than  two  hours  one  day,  ij/^  the  next,  and  patient 
made  only  24  cents  this  morning.  Patient  is  discouraged  and  would  like  to 
change  to  a  firm  that  can  give  steady  work. 

Patient  made  two  chemises  by  hand  for  another  patient,  made  neatly 
and  well. 

Mr.  Steadman,  Delle  Ink  Co.,  telephoned  to.  He  will  see  patient  to-day 
and  if  she  is  good  will  start  her  there.  She  would  make  $6  a  week  for 
about  two  weeks  and  then  go  on  to  piece  work  at  zzVi  per  cent  over  regu- 
lar piece  work  prices  which  would  gradually  be  reduced  until  in  about  four 
or  five  weeks  she  would  be  at  a  regular  rate.  If  she  is  good  with  her 
hands  she  might  later  work  into  piece  work  that  gives  $10  to  $13  a  week. 
HA/C 

March  13. 

Patient's  employer,  Dalton  Fastener  Co.,  Mr.  James,  seen  at  factory. 
Belle  Ave.,  Cambridge  (near  Central  Sq.).  Says  patient  returned  to  fac- 
tory on  3/10/16  after  employees  had  been  dismissed  early  to  tell  him  she 
had  obtained  other  work,  but  he  had  gone,  so  she  sent  letter  which  he 
received  next  day.  Patient  was  entirely  satisfactory  as  a  worker  and  got 
on  well  with  other  employees.  She  made  about  $9  a  week  on  piece 
work,  which  is  on  ball  and  socket  fasteners  for  automobile  tops,  tending 
machines,  sorting  and  packing.  Informant  would  reemploy  patient  when- 
ever they  need  help.     She  might  make  as  high  as  $16  a  week  on  piece  work. 


APPENDIX    A  653 

1916 

Impression :  A  young  man  of  intelligent  appearance  and  kindly  manner, 
apparently  genuinely  interested  in  the  welfare  of  his  employees. 

Impression  of  Factory :  Visitor  was  shown  room  where  patient 
worked.  A  large,  very  bright  room,  not  crowded  with  machinery  or 
workers,  but  exceedingly  noisy.  Factory  is  a  new  one.  Workers  can  eat 
lunch  in  room  where  they  work,  for  which  tables  are  cleared  and  ma- 
chinery is  stopped  for  an  hour.  Women  employed  are  Americans. 
AEL/C 

March  21. 

Patient  writes  about  every  other  day.  She  says  she  likes  her  work 
and  is  receiving  $6  a  week  for  the  first  two  weeks.  Hours  are  7  :30-i2 ; 
12:45-5:30,  or  9^  hours  a  day,  and  7:30-1,  or  5^  hours,  Saturdays;  total, 
51^  hours  a  week.  She  is  labelling  and  packing  bottles.  The  work  can 
be  done  faster  standing.     Stools  are  provided,  but  patient  stands. 

All  patient's  back  board  and  two  weeks'  board  advanced  by  Mr.  Young 
was  paid  3/6/16.  Patient  saved  the  money  which  would  have  gone  to 
carfares  and  bought  an  attractive  blue  corduroy  coat  for  about  $5.  Pa- 
tient will  keep  an  account  book  of  all  week's  wages  and  expenditures. 
Board  is  now  $4. 

Patient  now  has  a  new  roommate,  Nancy  Bornstein  (also  a  patient. 
File  No.  7246),  who  is  under  the  care  of  Miss  Stella  Farrell,  Massachusetts 
General  Hospital  Social  Service.  She  is  a  great  trial  to  patient  who  is  try- 
ing to  train  her  in  manners,  cleanliness,  and  industry.  Nancy's  diagnosis 
is  Not  Insane  (Moron — Hysteria).  Patient  goes  with  her  to  see  Miss 
Farrell. 

Last  week  at  visitor's  suggestion  patient  offered  her  mother  $1  which 
was  refused.     See  letter  of  3/20/16  from  patient. 
HA/C 

March  27. 

Massachusetts  General  Hospital  Social  Service,  Miss  Farrell,  tele- 
phones about  patient's  roommate  who  is  under  her  supervision.  Nancy  is 
under  Dr.  Fenmore's  care  at  Massachusetts  General  Hospital  nerve  clinic. 
She  is  to  stay  on  as  long  as  possible  at  Gordon  House. 

Patient  writes.     See  letters. 

Mother  seen  at  home.  Patient  has  been  in  church  very  little  in  Rox- 
bury,  about  three  or  four  times,  and  mother  suspects  that  she  continues  to 
go  to  St.  James.  When  she  used  to  go  there  she  made  friends  with  a  girl 
who  had  an  illegitimate  child,  and  this  child  was  boarded  out  with  people 
who  drank.  Mother  suspects  that  patient  continues  to  see  this  girl,  because 
she  asked  her  sister  about  making  a  dress  for  a  baby  two  years  old. 
Patient  was  godmother  to  this  child. 

Patient  wishes  to  stay  at  home  Saturday  nights  and  sometimes  talks 
about  going  home  to  live.  Mother  is  very  unwilling  to  say  that  she  does 
not  want  her  at  home,  but  it  is  evident  that  the  patient  is  a  trial  to  them. 
She  stays  in  bed  late  and  does  not  go  to  church  and  does  a  great  deal  of 
washing  and  odd  jobs  about  the  house  which  leaves  a  good  deal  of  dis- 
order. She  once  said  she  was  staying  at  Gordon  House  as  a  punishment. 
Mother  does  not  wish  to  take  money  from  the  patient,  because  in  the  past 
she  has  "thrown  it  up  at  them"  for  doing  so.  She  does  not  want  to  be 
under  any  obligation  to  the  patient.  In  regard  to  the  incident  about  the 
tea  mentioned  in  her  letter  of  3/20,  mother  says  that  she  off-ered  to  pay 
for  the  tea  from  the  beginning. 

Mother  thinks  that  the  patient's  present  roommate  is  not  good  for  her. 


654 


APPENDIX    A 


1916 

She  always  has  taken  things  hard  and  thinks  too  much  about  this  girl. 
Thinks  patient  has  improved  somewhat,  especially  in  her  talk,  which  used 
to  be  profane  and  disagreeable.  Mother  thinks  that  the  visitor  has  a  good 
deal  of  influence  over  the  patient,  but  that  patient  "puts  on"  a  great  deal 
of  her  own  goodness. 
HA/C 

March  28. 

Sister  Florence  met  in  town.  She  feels  as  mother  does  about  the 
money,  but  is  willing  to  have  patient  give  $1  a  week  if  it  is  necessary. 

Patient  told  her  employer  at  Dalton  Fastener  Co.  that  she  could  not 
support  her  invalid  mother  on  what  she  earned.  She  is  always  misrepre- 
senting family  situations  to  sister's  friends.  Patient  and  her  brother  Ber- 
nard never  got  along  together  and  sister  is  much  amused  at  patient's  pre- 
tending to  take  such  an  interest  in  him. 

Sister  will  let  visitor  know  the  first  time  patient  mentions  the  money 
she  gives  her  mother. 

Patient  seen  at  Gordon  House.  Though  7 130  she  is  ready  for  bed. 
She  gets  so  tired  standing  at  work  that  she  usually  goes  to  bed  or  reads 
after  dinner.  Patient  bathes  once  a  week  at  home  and  will  not  use  the 
tub  here  because  everyone  uses  it. 

Patient  does  not  go  out  evenings,  both  she  and  her  roommate  say. 
Nancy  relates  the  fun  which  they  have  together  evenings,  eating  oranges 
and  joking.  Nancy  is  apparently  fond  of  patient  and  an  admirer.  She 
says  "Harriet  is  smart."  Patient  is  crocheting  a  large  door  mat  out  of 
heavy  string.  She  is  also  making  a  complicated  work  bag.  Patient  has  a 
library  card  and  reads  a  good  deal.  The  gas  light  is  at  one  side  and  gives 
a  poor  light. 

Patient  goes  to  church  every  Sunday  at  some  Episcopal  church  and  has 
been  to  St.  James  several  times.  If  she  is  allowed  to  go  home  Saturday 
nights,  she  will  go  to  the  Unitarian  Church,  but  she  does  '..ot  take  much 
interest  in  it.  Patient  begs  to  be  allowed  to  go  home  Saturdays.  She 
speaks  of  living  at  home  later;  says  one  feels  freer  as  to  hours  and  all. 

Patient  continues  on  time  work  at  $6  a  week  (third  week)  but  the  fore- 
lady  praised  her  work.     She  has  talked  to  Hilda  Tibbets   (also  a  patient 
here)  and  asks  if  she  can  do  anything  for  her  as  she  has  noticed  that  no 
one  talks  to  her. 
HA/C 

March  30. 

Mother  writes.    See  letter  and  copy  of  answer.    Visitor  suggests  pa- 
tient go  home  Saturdays  for  a  trial. 
HA/C 

March  31. 

Patient  zvrites.     See  two  letters. 

Patient  telephones  to  say  she  does  not  want  to  appear  at  a  staflF  meeting 
of  N.  E.  Hospital  Social  Workers'  Association,  but  finally  agrees.  Patient 
will  start  staying  at  home  Saturday  nights. 

Gordon  House,  Miss  Dickinson,  telephoned  to  about  Saturday  arrange- 
ment.    Patient  is  in  almost  every  evening  or  else  comes  in  very  early. 
HA/C 

April  3. 

Employer,  Mr.  Stcadman.  Dclle  Ink  Co..  telephoned  to.  Patient  is 
doing  average  work  and  though  it  is  usually  customary  for  new  workers  to 
stay  six  weeks  on  time  work  he  will  allow  her  to  try  piece  work  next  week. 


APPENDIX    A  655 

1916 

Patient  writes  3/30,  3/31,  4/3.  See  letters.  She  gave  ner  mother  50 
cents  this  week. 

Patient  called  at  hospital  this  evening  and  left  a  present  for  visitor — • 
crocheted  slippers  which  she  had  made  herself. 
HA/C 

April  4. 

Patient's  roommate  writes.    See  letter. 
HA/C 

April  5. 

Patient  seen.  She  gave  visitor  her  gold  cross  and  chain  because  now 
she  is  a  Unitarian  she  cannot  wear  it. 

Patient  presented  at  a  clinic  at  the  Massachusetts  General  Hospital 
meeting  of  N.  E.  Hospital  Social  Workers'  Association.  When  asked  to 
tell  about  her  experiences  she  gave  a  very  direct  and  clear  account  of  how 
discouraged  she  had  been  before  taking  poison,  of  how  much  it  meant  to 
her  to  have  someone  take  an  interest  and  encourage  her  as  the  hospital 
people  had,  how  the  life  and  jolly  times  at  Gordon  House  had  made  her 
happy. 

Patient  and  her  roommate  given  tickets  to  see  "Grumpy."  . 
HA/C 

April  7. 

Patient  and  her  roommate  write.     See  letters. 
HA/C 

Mother  writes  that  patient  gave  her  50  cents  last  week.     See  letter. 
HA/C 

April  10. 

Patient  writes  that  she  has  lost  her  gold  watch,  the  gift  of  her  mother. 
She  is  much  discouraged  with  everything. 

Patient  telephoned  to. 
HA/C 

April  12. 

Patient  seen  by  Chief  of  Staff,  Dr.  Adler.  He  reports  that  she  recog- 
nizes that  her  depression  comes  in  six-month  periods.  She  is  now  passing 
through  the  period — the  previous  one  came  in  the  fall  when  she  took  poison. 
She  has  no  appetite,  sleeps  poorly,  is  disgusted  with  work  and  discouraged 
with  everything.     She  is  apt  to  go  back  to  drink. 

Patient  seen.  She  wants  to  get  back  into  printing  trade.  She  cannot 
take  much  interest  in  ink  work. 

A  shower  spray  was  sent  patient  last  week  and  she  bathes  twice  a  day 
now. 
HA/C 

April  17. 

Patient  writes  to-day  and  4/14.     See  letters. 
HA/C 

April  20. 

Patient  telephoned  to  every  day.  Her  appetite  is  better.  So  far  sug- 
gestions for  work  have  been  unsuccessful.  She  stayed  out  of  Delle's  this 
morning  to  go  to  two  places  for  work.  Patient's  watch  was  found  4/16 
at  church. 


656  APPENDIX   A 

1916 

Mr.  Norton  of  Sampson  Press  seen.  They  cannot  take  patient  back 
because  she  was  second  or  third  rate  worker,  her  attendance  was  very 
irregular,  and  they  have  no  opening. 

Mother  seen  at  home.  Visitor  had  alread)^  explained  to  sister  by  tele- 
phone last  week  that  this  is  a  critical  time  with  patient.  Mother  seems  to 
be  a  whiney  individual.  She  repeats  a  good  deal  of  past  history  in  great 
detail. 

Sister  sat  up  until  midnight  last  Saturday  trimming  a  hat  for  patient 
to  wear  to  church.     She  never  came  until  after  church. 

Patient  was  at  home  over  yesterday's  holiday. 
HA/C 

April  22. 

Patient  seen  at  hospital.  She  feels  encouraged  about  her  work  because 
she  made  $7  at  piece  work,  even  though  there  was  a  holiday.  She  will 
continue  at  least  one  week  more.  Then  she  may  stop  and  try  to  find 
printing  or  some  kind  of  work  at  which  she  can  sit.  The  standing  is  diffi- 
cult at  Delle's.  Patient  has  enough  money  in  the  bank  to  pay  her  own 
board  while  out  of  work.     She  cannot  remember  the  exact  amount. 

Her  roommate  is  more  restless  and  queer  of  late  so  that  patient  has  not 
had  the  proper  amount  of  sleep.  At  midnight  she  got  up  and  tried  to  go  off 
so  that  patient  had  to  call  the  matron. 

Patient's  appetite  is  good  now  and  she  has  almost  no  desire  for  drink. 

She  has  made  two  tea  aprons  for  another  patient  and  done  them  well. 
HA/C 

April  26. 

Patient  has  written  and  telephoned  tzvice.  She  has  secured  work  at 
Doherty's,  181  Norfolk  Ave.,  hours  7  :30-5  -.30.  Thinks  the  pay  will  be  $7 
or  $8  per  week.  She  sets  type  for  menus  for  hotels.  She  only  worked 
until  3  :30  to-day.  Patient  seems  very  happy  over  her  new  work,  is  much 
interested,  and  "the  day  simply  flies." 
MC/C 

April  28. 

Patient  seen  at  Gordon  House.   She  was  tired  and  had  a  headache,  and 
she  went  to  bed  early.     She  had  had  a  tooth  extracted.     Nancy  has  refused 
to  speak  to  her  for  several  days. 
MC/C 

April  28. 

Gordon  House,  Mrs.  Dickinson  seen.    She  has  decided  that  Nancy  can- 
not stay  at  the  House  any  longer  and  she  is  waiting  to  hear  from  Miss 
Farrell.     They  all  like  patient  very  much.     She  does  not  think  it  is  best  for 
oatient  to  have  the  care  of  Nancy. 
MC/C 

May  2. 

Patient  seen.    At  patient's  invitation,  visitor  and  patient  attended  re- 
cital at  Jacob  Sleeper  Hall  given  by  Curry  School  of  Expression. 
MC/C 

May  5. 

Patient  seen  at  visitor's  residence.     She  walks  to  her  work  every  day 
now.    She  has  to  stay  until  4:30  on  Saturday  afternoons,  but  will  not  have 
to  do  this  in  the  summer. 
MC/C 

May  8.  _  ■  . 

Patient  writes.     See  letter. 
MC/C 


APPENDIX    A  657 

1916 

May  8. 

Patient  telephones.     She  is  worrying  for  fear  she  will  have  to  go  home 
to  live.     Says  she  has  been  "thirsty  all  day  and  drinks  a  large  quantity  of 
water." 
MC/C 

May  12. 

Patient  writes.    See  letter. 
MC/C 

May  IS- 

Gordon  House,  Mrs.  Dickinson,  telephoned  to.  Nancy  came  back  to 
the  House  for  the  night  only.  Miss  Farrell  said  Nancy  had  no  place  to  go 
so  Mrs.  Dickinson  gave  her  the  room  for  two  days  and  a  night.  She  did 
not  see  patient  at  dinner  so  she  probably  left  immediately  after  she 
came  home. 
MC/C 

May  15. 

Patient  telephones.  She  is  at  her  mother's  and  wants  to  stay  all  night 
because  she  is  angry  because  Nancy  came  back  to  room  with  her.  She 
understood  that  she  was  to  have  a  new  roommate.  Visitor  advised  patient 
to  go  back  to  the  Settlement  House. 

Patient  telephones  later  that  she  has  decided  to  return  and  is  on  her 
way  there  now. 
MC/C 

May  28. 

Patient  telephones  that  she  fainted  at  work  yesterday  because  of  men- 
struation.    She  is  at  home  and  resting  to-day. 
MC/C 

Patient  telephones  and  writes  often.     See  letters.     She  likes  her  work 
and  has  made  friends  with  girls  at  the  shop. 
HA/C 

May  29. 

Patient  writes  details  of  a  medical  nature.  See  letter.  She  has  crav- 
ing for  drink  and  takes  vinegar  and  water,  lemon  and  limes,  and  anything 
she  can  think  of. 

She  goes  out  to  supper  occasionally. 
HA/C 

May  31. 

Patient  writes  and  telephones.     She  tried  to  work  Monday  S/29,  but 
had  to  leave  in  early  afternoon. 
HA/C 

June  2. 

Patient  seen  at  hospital.  She  is  anxious  to  live  at  home  now.  She 
feels  dissatisfied  with  the  food  at  Gordon  House  because  it  is  too  salty  and 
makes  her  thirsty.  Visitor  urged  against  going  home,  but  left  decision 
pending. 

Patient  gives  her  mother  $1  a  week;  earns  $8.  She  goes  on  the  car 
now.     She  is  able  to  save,  out  of  the  remaining  $7,  $2.40. 

Patient  says  she  is  going  out  with  a  man  older  than  herself.  The 
affair  is  a  serious  one  though  patient  has  not  yet  decided  to  marry  him. 
From  everything  she  can  hear,  he  is  a  good  sort.  She  refuses  further 
details  on  the  ground  that  her  previous  affair  with  Karl  Cauldwell  was 
broken  up  by  interference  from  other  people, 
HA/C 


658 


APPENDIX    A 


1916 
June  5. 

Patient  writes  that  she  has  decided  not  to  go  home  to  live.    This  week- 
end she  thought  her  mother  and  sister  were  very  severe  and  strict  with  her. 
See  letter. 
HA/C 

June  6. 

Matron,  Gordon  House,  Mrs.  Dickinson,  seen.  Food  is  not  salty. 
They  always  have  fresh  meat  and  fish  and  only  occasionally  ham.  At 
dinner  they  have  potatoes  and  two  vegetables,  or  one  vegetable  and  lettuce. 
Matron  has  found  that  patient  exaggerates  and  cannot  be  depended  upon 
to  keep  strictly  to  the  truth.  Illustrations  given  seemed  to  have  discrep- 
ancy of  detail  rather  than  entire  false  basis. 

There  is  no  one  to  room  with  patient  at  present,  but  matron  will  have 
it  in  mind  to  put  some  one  with  her  when  she  can.  Patient  is  well  liked 
Ijy  the  girls,  is  friendly,  agreeable  to  every  one,  and  seems  well  behaved. 
She  is  in  most  of  the  time,  but  goes  home  to  dinner  occasionally  on  week 
nights. 
HA/C 

June  8. 

Patient  reported  at  hospital.  Was  seen  by  Dr.  Green  and  given  advice 
about  menstrual  period. 

Dr.  Wilson  had  a  long  talk  with  patient  and  says  he  thinks  she  is  fairly 
contented ;  that  there  is  nothing  to  the  love  affair.     Patient  is  doing  well. 
HA/C 

June  10. 

Patient  writes  and  telephones.  She  has  a  chance  to  work  three  even- 
ings a  week  in  a  store  in  Kensington,  but  is  advised  not  to  do  so,  because 
of  extra  wear. 

She  has  given  up  the  young  man  by  going  off  and  leaving  him  looking 
in  a  store  window.     He  wanted  to  give  her  a  dog  for  which  she  had  no 
place. 
HA/C 

June  13. 

Patient  writes. 
HA/C 

June  23. 

Patient  zvrites  and  telephones  often.  She  went  to  Y.  ]\I.  C.  A.  Enter- 
tainment one  night  with  Henry  Elkins,  whom  she  knew  at  Sampson  Press. 
He  is  a  widower  who  is  going  to  be  married  again  next  month. 

Patient  is  writing  short  stories,  a  sample  of  which  shows  very  word}^ 
and  flowery  style  with  a  romantic  and  imaginative  background. 
HA/C 

June  23. 

Minister,  Mr.  Young,  telephones  to  inquire  how  patient  is  doing.     He 
advises  strongly  that  patient  and  family  both  be  urged  against  patient's 
ever  going  home  to  live. 
HA/C 

June  23. 

Patient  seen  at  hospital.  She  wanted  to  explain  to  visitor  about  fellow 
employees  who  are  not  altogether  agreeable  with  her.  Patient  and  Martha 
Wilson,  who  soon  leaves  to  be  married,  are  the  only  Protestants.  Since 
the  other  girls  found  this  out,  they  have  gone  cut  of  their  way  to  be  dis- 
agreeable and  troublesome ;  for  example,  patient  will  just  get  her  hand  full 
of  type  and  be  seated  on  her  stool,  when  they  decide  to  get  certain  trays 


APPENDIX    A  659 

1916 

under  her  stool,  so  that  she  has  to  get  down.     They  'kick  her  standing  box 
to  the  other  side  of  the  room  whenever  they  get  a  chance.     Patient  will  do 
her  best  to  stand  it  and  report  to  visitor  before  leaving. 
HA/C 

July  3I-. 

Patient  seen  often  in  past  month.  She  continues  to  write  and  telephone 
often.  See  letters.  She  has  one  friend,  James  V.,  who  lives  across  the 
street  from  hospital.  She  "picked  him  up"  through  the  window  while  she 
was  on  Ward  V.  Went  out  to  suppers,  several  dances,  and  to  ride  with 
three  or  four  different  men,  but  would  not  tell  visitor  about  them. 

Patient  once  brought  up  question  of  going  home  to  live,  but  after  two 
days'  consideration  decided  against  it.  Mother  and  sister  have  been  in 
Dover  part  of  month  and  patient  went  there  for  week-ends. 

August  15. 

Patient  seen  and  writes  often.  James  V.  went  to  Bloomington,  111.,  to 
work  two  days  ago  and  patient  has  been  quite  blue  ever  since.  She  takes 
no  interest  in  the  other  men  and  is  going  to  give  them  up  entirely.  One 
made  improper  advances  to  her  by  saying  something  and  patient  will  not 
have  anything  to  do  with  him.  Had  a  long  talk  with  patient  On  this  sub- 
ject, but  could  get  no  definite  accovmt  from  her  of  her  own  affairs.  She 
has  never  been  "immoral" — her  mother  would  put  her  out  if  she  were,  she 
says. 

Patient  is  found  to  have  pinworms.  She  reported  to  O.  P.  D.,  Dr. 
Samuejs,  who  prescribed  for  her. 

Employer,  Mr.  Simpson,  a  foreman  at  Doherfy  Printers,  seen.  He  says 
patient's  work  is  good.  She  has  not  shown  any  special  discouragement 
(patient  wrote  she  thought  he  saw  her  crying).  He  was  not  planning  on 
giving  her  a  vacation,  but  if  visitor  thinks  she  needs  one  he  will  arrange  it. 
Employer  is  not  given  name  of  visitor  or  hospital,  nor  did  he  ask.  Patient 
was  not  seen. 

Impression :    Intelligent  young  man  who  is  kind  and  sympathetic. 
HA/C 

August  17. 

Mother  writes,  saying  that  patient  seems  to  be  getting  restless  and  talks 
©f  going  home  to  live  and  she  fears  that  as  soon  as  visitor  leaves  patient 
will  disarrange  things. 

Patient  taken  to  dinner.  A  Mrs.  Davis  asked  her  to  live  with  her. 
Patient  would  have  the  use  of  the  kitchen  and  better  meals.  Room  rent 
would  be  free.  Mrs.  Davis  is  an  old  friend  as  well  as  a  fellow  employee 
at  Dalton  Fastener  Co.  Patient  also  brings  up  the  question  of  going  home 
to  live,  but  promised  visitor  to  make  no  such  change  during  her  absence 
nor  to  talk  about  it  to  her  mother. 

Patient  told  of  opportunity  to  go  to  Hampton  Rest  the  first  week  in 
September  and  thinks  that  she  would  prefer  to  go  to  her  brother's  in  Dover. 
She  will  write  him  and  find  out  whether  he  can  have  her. 
HA/C 

August  26. 

_  Matron,  Mrs.  Thom-pson,  Gordon  House,  seen.  She  was  surprised  that 
patient  complained  of  waiting  on  table  because  she  has  never  seen  her  do  it, 
although  patient  is  supposed  to  do  her  share.  She  has  not  spoken  of  it 
because  weather  has  been  so  warm  and  patient  has  s_eemed  so  tired.    Patient 


66o  APPENDIX    A 

1916 

seems  worried  and  unhappy,  probably  because  she  would  like  to  be  at  home, 

but  has  decided  to  abide  by  the  doctor's  advice  to  stay  away. 

Patient  is  to  have  a  roommate,  beginning  to-night. 
MW/C 

August  26. 

Patient  telephoned  to  at  i  :30.  She  has  decided  to  go  to  her  brother's 
in  Dover  for  her  vacation.  She  sounded  happy  and  seemed  pleased  at  being 
called  up. 

Hampton  Rest  written  to,  saying  patient  will  not  take  their  place. 
MW/C 

August  31-  .  . 

Patient  called  at  hospital  in  evening  and  asked  advice  about  moving 
from  Gordon  House.  She  is  dissatisfied  and  says  the  new  matron  is  too 
strict.  She  has  asked  her  repeatedly  to  wait  on  table,  has  not  had  a  place 
set  for  her  when  patient  returned  after  a  week-end  at  home,  and  told  her 
new  roommate  that  patient  has  spells  of  depression.  Patient  thought  of 
taking  her  things  home  this  week-end  and  living  there  after  her  vacation 
until  a  new  place  can  be  found.  Visitor  advised  leaving  things  as  they  are 
and  staying  at  the  Gordon  House  until  INIiss  Bemis  returns  and  new  .ar- 
rangements can  be  made.  Patient  promised  to  abide  by  this  and  went  away 
happy. 
MW/C 

September  30. 

Patient  seen  two  or  three  times  and  writes  and  telephones  often.  See 
letters.  At  first  she  wished  to  move  on  return  from  her  vacation  at  her 
brother's  in  Dover ;  she  had  a  new  roommate  and  was  content  to  stay  on. 
Roommate,  Frances  Caldwell,  is  a  Church  Home  girl  of  18,  young,  attrac- 
tive, and  not  undesirable  or  bad.  Patient  is  very  superstitious  and  believed 
what  a  fortune  teller  told  her,  interpreting  that  brother,  Benjamin,  was 
working  against  her  particularly  with  mother.  She  writes  she  intends  to 
make  over  her  insurance  to  visitor. 

Patient  had  one  crying  spell  at  work  before  menstruation  period.  Has 
been  to  Out-Patient  Department  and  given  treatment  by  Dr.  Samuels  for 
pinworms. 

Patient  has  taken  an  account  book  and  will  keep  track  of  her  expenses. 
Is  interested  in  doing  so. 

Room  visited  and  patient  keeps  it  cozy  and  pleasant. 
HA/C 

October  31. 

Mother  visited  10/6.  She  does  not  want  patient's  financial  assistance 
of  $1  because  she  is  apt  to  throw  it  up  to  her  that  she  gives  money.  Per- 
suaded to  continue  taking  it.  Patient  does  not  go  to  Unitarian  Church. 
When  she  comes  home,  she  is  as  disagreeable  and  vulgar  as  ever. 

Patient  seen  three  or  four  times.  Moved  10/21  to  the  Inman  House, 
taking  her  roommate,  Frances  Caldwell,  with  her.  Became  dissatisfied  with 
new  matron,  Mrs.  Thompson.  Roommate  was  hot-tempered  and  saucy  and 
wanted  to  leave.  Before  going  patient  had  a  talk  with  matron  who  felt 
more  kindly  disposed  toward  her.  Patient  has  several  young  men  with 
whom  she  goes  out  to  dinner  and  she  claims  she  is  not  at  the  house  many 
times  a  week.  10/24  patient  was  disagreeable  and  sullen  over  telephone  and 
said  she  was  going  out  on  the  streets.  Wrote  next  day  apologizing.  Patient 
telephones  and  writes  often.     See  letters. 


APPENDIX    A  66l 

1916 

Matron,  Mrs.  Thompson,  seen.     She  has  nothing  to  say  against  patient 
and  thinks  she  is  a  nice  girl.     They  had  a  good  talk  before  patient  left. 
Patient  was  not  absent  from  meals  that  she  noticed. 
HA/C 

November  30. 

Patient  seen  twice,  writes  and  telephones  often.  Has  made  several 
things  for  patients'  Christmas  tree,  crochet  baby  sacks  and  slippers. 

Patient  is  going  to  evening  dental  clinic  at  Boston  Dispensary,  referred 
by  visitor.     Was  out  of  work  a  day  at  menses. 

She  complains  of  their  third  roommate,  a  nurse,  who  is  not  sociable 
and  who  they  think  tries  to  annoy  them  and  be  inconsiderate.  Patient  does 
not  make  friends  with  the  others  in  the  house  and  goes  out  evenings  a  good 
deal  with  men,  coming  in  early.  The  boys'  living  club  similar  to  this  gave 
a  party  to  the  girls  which  patient  seemed  to  enjoy. 

Middle  of  month  patient  was  determined  to  go  home  to  live  and  would 
not  promise  visitor  not  to  move.  Three  hours  later  telephoned  she  would 
stay  where  she  was.  Patient  became  angry  at  family  and  said  she  did  not 
intend  to  go  in  to  see  them  again,  at  least  will  not  sleep  there  any  more. 
See  letters. 

Former  friend.  Miss  Simpson,  governess  of  Mrs.  M.  C.  Saunders'  chil- 
dren, telephones  to  inquire  for  patient  and  says  she  expects  to  go  to  see  her. 
She  used  to  know  her  at  St.  James  Church  and  had  lost  track  of  her  until 
recently  hearing  of  her  coming  to  the  hospital. 

Mother  writes  patient  brings  her  washing  home  and  it  is  too  much  for 
her  to  do.     (Laundry  is  not  done  at  this  house.)     See  letters. 
HA/C 

December  30. 

Patient  seen,  telephones  and  writes.  Has  contributed  3  or  4  presents 
to  the  Christmas  tree  and  takes  much  interest  in  doing  so.  The  settlement 
club  at  Ferris  Memorial,  to  which  visitor  referred  patient,  has  not  been 
active.  Once  patient  went  and  it  was  a  Jewish  holiday  and  no  others  were 
there  and  last  time  only  two  or  three,  so  that  she  is  discouraged  with  it. 

Patient  was  referred  to  Miss  Harriet  Martin  (Boston  Society  for  Care 
of  Girls)  for  one  of  the  new  Girls'  Protective  Leagues.  These  are  to  be 
made  from  clubs  already  established,  but  Miss  Martin  will  keep  patient  in 
mind.  Patient  has  been  to  church  with  Miss  Simpson.  Is  now  going  fre- 
quently to  Episcopal  Church. 

December  31. 

Patient  seen  three  or  four  times.  At  end  of  month  had  a  large  and 
serious  abscess  in  her  tooth  which  gave  her  much  pain  and  kept  her  from 
work  a  week.     Spent  a  good  deal  of  time  at  home. 

Patient  has  a  laundress  and  does  not  take  washing  home  to  mother. 

See  letters. 
HA/C 

1917 
January  31. 

Patient  seen  a  number  of  times.  Patient  became  dissatisfied  with  In- 
man  House  because  Matron,  Mrs.  Sawtelle,  was  not  considerate  of  her 
when  she  was  sick,  because  she  did  not  like  the  third  roommate,  and  be- 
cause Frances  Caldwell  moved  to  her  sister's.  Effort  was  made  to  have 
patient  return  to  Gordon  House,  but  they  refused  to  take  her  back  but 
would  give  no  reason,  i/ii — After  staying  home  three  days  patient  moved 
to  Warrenton  St.  Y.  W.  C.  A.     She  has  been  very  enthusiastic  about  it  since. 


662  APPENDIX   A 

I917 

Patient  knows  several  girls  from  Gordon  House  who  room  there.  Patient 
introduced  them  to  visitor  and  they  seemed  nice,  wholesome  working 
women,  friendly  toward  patient. 

Patient  was  out  of  work  half  a  week  with  the  abscess.  1/8  she  went 
to  Massachusetts  General  Hospital  Out-Patient  Department  for  advice  in 
treatment  of  worms  and  was  given  medicine. 

Mother  wrote  1/8,  fearing  patient  was  planning  to  move  home.     See 
letter. 
HA/C 

February  28. 

Patient  seen.  Writes  often ;  see  letters.  2/12  patient  wrote  "best  of 
friends  must  part"  and  "I  will  not  trouble  you  any  more."  Interview 
brought  out  fact  that  because  patient  was  told  over  telephone  that  visitor 
was  "out"  she  thought  visitor  did  not  wish  to  hear  from  her.  Episode  was 
smoothed  over. 

In  past  six  weeks  patient  has  not  been  going  to  church  much.  Is  urged 
but  does  not  wish  to.     Later  writes  she  goes  to  Catholic  Church  at  noons. 

Patient  made  a  chemise  for  a  sick  patient  and  called  for  another  girl 
patient  here  to  direct  her  to  Y.  W.  C  A. 

Friend,  James  V.,  who  lives  on  Granville  Road,  is  ill  with  mastoid  and 
patient  is  quite  upset  over  it.  She  has  known  him  over  a  year,  claiming  to 
have  picked  him  up  while  a  patient  in  Ward  V.  They  have  been  around 
together  a  good  deal  when  he  is  in  town.  Patient  tells  of  many  invitations 
to  go  out  with  men, 
HA/C 

March  31. 

Patient  seen  four  times  and  writes.  See  letters.  3/4  patient  wrote  she 
was  through  with  visitor  and  visitor  did  not  go  until  3/6  to  see  her.  She 
continued  to  think  she  was  abused  in  the  telephone  service,  her  chief  grudge 
being  that  she  could  not  reverse  a  business  call  because  visitor  was  out. 
Thinks  visitor  could  call  her  oftener.  During  month,  patient  has  telephoned 
very  little.  Relationship  continues  strained  through  the  month  over  tele- 
phone controversy,  which  patient  insists  is  putting  her  down.  She  cites 
every  instance  when  visitor  said  she  was  in  a  hurry  or  was  out  and  enlarges 
on  it. 

Went  with  patient  to  see  Mr.  Mittelman,  Vicar  of  St.  Matthew's 
Church,  and  patient  promises  to  go  again  and  has  already  been  to  several 
services. 

At  work  patient  had  $1  raise  in  pay  with  only  two  or  three  others  in 
the  shop,  making  $9  wage.     She  is  saving  money. 

First  of  month  Beftha  Greenwood  (also  Social  Service  case)  went  to 
live  across  from  patient.  She  had  previously  lived  at  Y.  W.  C.  A.  and  old 
girls  said  horrid  things  about  her  so  patient  was  snubbed  for  speaking  to 
her.  This  lasted  about  ten  days  and  is  still  a  factor  with  patient's  room- 
mate, who  now  seldom  speaks  to  her.  Patient  takes  some  pride  in  having 
befriended  Bertha,  who  tells  to  patient  untrue  things  about  visitor  and  to 
visitor  things  which  patient  does  not  do. 

April  30. 

Patient  seen  three  times.  Early  in  month  she  talked  of  moving  to  a 
private  family,  but  decided  against  it  of  her  own  accord.  Reported  that  a 
girl  in  the  house  had  offered  her  liquor  last  month. 

After  present  of  an  Easter  lily,  patient  was  friendly  and  like  herself 
until  4/24  she.  came  unexpectedly  in  the  evening  and  stayed  labours.  She 
was  cross  and  sullen  at  first  and  would  not  look  up.     She  criticized  visitor 


APPENDIX   A  663 

1917 

and  was  very  disagreeable.  Later  became  jolly  and  chatty.  Seemed  to 
have  come  just  to  "let  off  steam"  at  some  one  and  possibly  to  get  a  reaction 
from  visitor,  but  visitor  let  her  talk.  She  does  not  see  brother,  Bernard, 
now  and  plans  not  to  visit  there  week-ends  as  she  used  to  because  she  thinks 
he  talks  against  her  and  dislikes  her  visits.  Has  not  seen  him  since  3/25 
at  her  mother's. 

Patient  says  that  last  week  she  has  taken  a  glass  of  porter  every  night 
(pays  5  cents  for  it).  This  week  she  has  not  taken  it.  She  goes  out  and 
drinks  it  alone  because  it  makes  her  sleep  better.  She  has  been  restless  and 
sleepless  lately  and  has  a  loss  of  appetite.  Patient  promises  not  to  drink 
at  least  to  4/30. 

She  is  very  discouraged  and  thinks  visitor  is  only  interested  in  order  to 
find  something  on  her  to  put  her  awa}^.  Has  an  idea  which  cannot  be  dis- 
pelled that  visitor  is  a  probation  officer  (view  shared  by  Bertha  Green- 
wood). Thinks  she  is  followed  by  detectives  because  she  has  met  the  same 
man  several  successive  mornings  on  the  way  to  work.  Another  man  was 
seen  at  Y.  W.  corner  on  several  nights. 

Patient  was  seen  by  Dr.  Samuels,  Out-Patient  Department,  4/28,  and 
had  in  the  meanwhile  written  she  would  not  drink  again.  4/6  patient  visits 
mother  regularly  on  Sundays,  but  remains  only  30  or  40  minutes  and  refuses 
to  stay  to  meals.  Patient  v/as  in  a  very  disagreeable  mood  on  last  visit  4/1 
and  talked  incessantly  about  quarrels  with  different  girls  at  Y.  W.  C.  A. 
Mother  has  not  received_  any  financial  aid  from  patient  since  Christmas. 
For  past  two  months  patient  has  been  cool  and  indifferent  toward  mother 
and  sister.  The  sister  usually  met  patient  on  way  to  business,  but  has  not 
seen  her  during  the  past  week.  Both  mother  and  sister  are  worried  over 
the  estrangement. 
HA/C 

May  31. 

Patient  seen  3  times.  Was  rather  disagreeable  5/19  but  the  next  day 
wentto  Marshfield  Hills  with  visitor  to  see  Fern  Linnwood  (also  a  Social 
Service  case),  a  blind  woman  who  was  formerly  her  roommate.  Patient  is 
really  devoted  to  her  and  suggests  spending  her  vacation  at  the  same  house. 
Patient  has  been  on  excellent  terms  with  visitor  ever  since.  Does  not  put 
much  trust  in  Bertha  Greenwood,  and  sees  as  little  of  her  as  possible,  but 
rooming  across  from  her  this  is  difficult  to  accomplish. 

Patient  would  like  to  know  if   mother   really  needs  her  contribution. 
She  would  gladly  give  it,  but  has  a  feeling  it  is  not  wanted. 
HA/C 

June  I5._ 

Patient  seen  twice.  It  is  arranged  that  she  will  go  6/24  to  Marshfield 
Hills  with  Fern  Linnwood  for  her  vacation  at  the  rate  of  $7  a  week. 
Patient  has  promised  to  room  at  the  Y.  W.  C.  A.  during  visitor's  absence. 
The  istof  the  month  she  insisted  that  she  should  live  in  a  private  family 
and  while  efforts  were  being  made  to  find  one  patient  changed  her  mind. 
She  wrote  that  she  realized  if  she  came  home  tired  she  would  make  no 
effort  to  get  proper  food.     See  this  and  other  letters. 

Patient  is  friendly  and  responsive  to  visitor. 
HA/C 

July  5- 

Patient  seen  at  hospital.  Patient  says  that  she  does  not  feel  that  her 
week's  holiday  rested  her  as  much  as  it  ought  to  have.  Since  coming  back 
she  has  had  a  headache  almost  continually.  She  is  quite  sure  this  is  from 
her  eyes.     She  says  she  is  going  to  see  Dr.  Nelson,  an  oculist  on  Irving 


664 


APPENDIX    A 


1917 

Avenue,  about  them.  Visitor  urged  her  to  go  to  the  Bennett  St.  Dispensary 
and  not  spend  so  much  money.  She  is  skeptical  of  dispensaries.  Patient 
says  she  may  take  three  weeks'  holiday  soon,  as  work  is  slack  and  she  feels 
the  need  of  more  rest.  She  would  like  to  stay  in  her  room  and  sleep  and 
rest.  She  went  to  a  dance  Monday  night  at  Nantasket  with  her  young  man 
friend.  He  is  continually  coming  to  see  her  and  wanting  her  to  go  out 
with  him.  She  finds  him  rather  tiresome. 
SPE/C 

July  20. 

Patient  seen  at  work,  292  Nottingham  Ave.  Patient  says  the  principal 
reason  that  she  wanted  to  change  her  room  was  because  her  roommate  was 
away  and  it  was  quite  likely  that  a  transient  would  be  put  with  her.  They 
are  often  brought  in  in  the  middle  of  the  night  and  they  are  quite  often 
girls  that  you  cannot  trust  at  all.  Patient  says  that  she  has  a  nice  room 
at  the  Y.  W.  C.  A.  and  would  hate  to  give  it  up  as  she  feels  as  if  it  was 
quite  like  home.  Says  she  will  wait  till  Miss  Bemis  comes  back  and  talks 
it  over  with  her.  Patient  said  she  had  spent  a  very  happy  Sunday  with 
Fern  Linnwood,  a  Social  Service  case.  Patient  seems  to  take  a  great  in- 
terest in  Bertha  Greenwood  and  plans  different  things  to  keep  her  from 
getting  into  trouble.  Patient  did  not  seem  as  depressed  as  letter  had 
indicated. 
HA/C 

Matron,  Y.  W.  C.  A.,  Mrs.  Denecn,  seen  at  68  Warrenton  St.  Informant 
says  as  far  as  she  knows  patient  has  been  going  to  her  work  and  doing 
perfectly  well  in  every  way.  A  certain  crowd  of  girls  in  the  house  were 
very  noisy  on  Sunday,  but  there  was  no  drinking.  She  knew  patient  was 
not  in  this  crowd  as  she  was  away.  Informant  says  she  did  not  ask  patient 
if  she  had  been  drinking  as  she  does  not  know  who  it  was.  Informant 
thinks  patient  is  very  apt  to  exaggerate  small  incidents. 

July  21. 

Letter  received  from  patient.     See  letter. 
SPE/C 

August  2. 

Patient  writes,  asking  advice  in  regard  to  medical  examination.  Family 
are  anxious  to  have  her  see  physician.  Patient  insists  on  woman  physician. 
MRW/C 

August  6. 

Neiv  England  Hospital,  O.P.D.,  telephoned  to.  Dr.  Zcaring  reports 
no  evening  clinics. 

August  7. 

Dr.  Margaret  K.  Dcniing  telephoned  to  at  56  Chenowcth  Road.  Dr. 
Denying  will  see  patient  any  Wednesday  evening  on  her  way  home  from 
work  between  5-6:30  p.  M.  Will  accept  visitor's  recommendation  as  to  what 
fee  should  be. 

Patient  visited  at  Y.  W.  C.  A.  Patient  very  communicative  and  friendly. 
Talks  much.  Physical  symptoms  gone  into.  Nothing  apparent  save  painful 
and  too  frequent  menstruation  with  its  accompanying  depression.  Patient 
thinks  mother  unnecessarily  worried.  Agrees  to  see  Dr.  Deming  Wednes- 
day evening,  August  15,  and  give  her  frank  history.  Is  rooming  at  present 
with  Bertha  Greenwood  because  she  did  not  like  transient  who  was 
put  into  her  room.  Hot  weather  created  desire  for  drink,  but  claims  she 
took  nothing. 
MRW/C 


APPENDIX    A  665 

1917 
August  8. 

Dr.  Deming  telephoned  to. 
MRW/C 

August  13. 

Letter  written  to  patient. 

Social  summary  sent  to  Dr.  Margaret  Deming. 
MRW/C 

August  14. 

Patient  telephones  in  much  disturbed  condition  because  she  has  been 
told  that  Miss  Bemis  is  not  returning  and  feels  that  hospital  has  been 
trying  to  deceive  her.  Her  point  of  view  is  that  if  the  hospital  lies  to  her 
in  one  thing  it  cannot  be  trusted  in  any.  Situation  finally  explained  after 
10  or  15  minutes'  conversation.  Patient  asks  visitor  to  write  Mrs.  Deneen 
to  see  if  it  can  be  arranged  for  her  to  have  a  single  room.  Complains  of 
being  much  upset  by  frequent  arrival  of  transients. 
MRW/C 

August  15.  • 

Letter  written  to  Mrs.  Deneen,  Y.  W.  C.  A. 
MRW/C 

August  15. 

Telephoned  to  Dr.  Margaret  K.  Deming,  56  Chenoweth  Road.  Dr. 
Deming  reports  that  she  gave  a_  full  physical  examination  to  patient  last 
evening  and  fiods  her  lungs  and  heart  negative.  Patient  eight  pounds  under 
weight.  Dr.  Deming  considers  that  the  pain  experienced  at  the  menstrual 
periods  is  due  largely  to  her  generally  run-down  physical  condition.  Has 
given  her  a  tonic  and  is  to  see  her  again  on  September  5.  If  patient  then 
continues  to  have  much  pain,  Dr.  Deming  will  give  a  local  examination. 
Finds  no  evidence  of  any  tubercular  bone  condition.  Feels  that  patient  is 
much  relieved  to  learn  this  and  also  to  know  that  her  heart  is  normal. 
Patient  paid  Dr.  Deming  two  dollars  for  the  visit. 
MRW/L 

August  17. 

Letter  received  from  patient.     See  letter. 
MRW/L 

August  17.  ... 

Letter  written  to  patient,  urging  her  to  follow  Dr.  Deming's  directions 
conscientiously. 
MRW/L 

August  17. 

Letter  written  to  Mrs.  Deneen,  Y.  W.  C.  A.,  68  Warrenton  St.,  asking 
her,  if  possible,  to  arrange  for  patient  to  have  a  room  by  herself. 
MRW/L 

August  20. 

Letter  from  patient,  stating   that  she  is  going  to  take  a  week  off  to  rest. 
Liked  Dr.  Deming  and  is  willing  to  do  what  she  has  advised.     Is  contented 
at  the  Y.  W.  C.  A.,  although  she  still  has  occasionally  longings  to  be  with 
her  own  people.     Dr.  Deming  has  advised  against  this  at  present. 
MRW/L 

August  21. 

Patient  seen  at  hospital.  Mrs.  Deneen  has  given  patient  a  room  by  her- 
self and  she  feels  much  better.  Is  resting  this  week,  getting  up  late  and 
going  away  for  day  trips.  Agrees  to  see  Dr.  Dixon  about  her  glasses  soon. 
MRW/L 


666  APPENDIX    A 

1917 

August  23. 

Letter  from  patient. 
MRW/L 

August  29. 

Letter  from  patient.     Seemed  depressed. 

Letter  to  patient. 
MRW/L 

September  i. 

Letter  from  patient. 
MRW/L 

September  4. 

Letter  from  patient. 
MRW/L 

September  5. 

Letter  to  patient. 
MRW/L 

September  12. 

Patient  seen  at  work  during  noon  hour.     Patient  looked  well  and  ap- 
peared in  good  spirits.     Talked  about  several  young  men  friends,  especially 
about  one  named  Young,  whom  she  refused  to  say  where  she  had  met. 
SPE/L 

September  19. 

Patient  seen  at  hospital.  Patient  appeared  extremely  "blue,"  played 
with  her  hands  in  a  nervous  way  and  cried.  She  said  th?t  she  dreaded 
having  the  operation,  but  she  supposed  if  it  really  would  help  her  she  would 
be  willing  to  go  through  with  it. 

Since  she  broke  off  with  her  friend,  Young,  she  says  a  well-dressed 
man  has  been  v»-atching  her  on  the  street  corner  and  making  remarks  to  he.'. 
She  has  a  feeling  that  this  man  may  be  a  detective  placed  there  by  Young. 

Patient   saw  Dr.   Harmon  and  after  talking   with   him   she  appeared 
somewhat  cheered. 
SPE/L 

September  25. 

Patient  seen  at  hospital.  Patient  brought  hat  and  shoes  to  be  given 
away.  She  appeared  in  a  much  more  cheerful  mood  since  last  seen  in  spite 
of  the  fact  that  a  great  family  friend,  whom  she  called  uncle,  had  just  died. 
SPE/L 

September  27. 

Dr.  Simpson  telephoned  to.  Informant  said  that  the  treatment  that 
patient  needed  would  only  keep  her  in  the  hospital  two  or  three  days 
After  that  she  should  have  a  week  or  two  of  convalescent  care.  Informant 
recommended  patient  going  to  the  Massachusetts  General  Hospital,  the 
Women's  Free  Hospital,  or  the  New  England  Hospital. 
SPE/L 

Patient  seen  at  noon.  Is  willing  to  go  to  Massachusetts  General  Hos- 
pital for  slight  operation  recommended  by  Dr.  Simpson.  She  is  very  loath 
to  go  to  a  convalescent  home  for  a  week  after,  but  finally  consents  to  go  to 
the  country  to  board. 

She  enjoys  her  single  room  at  the  Y.  W.  C.  A.  Her  family  are  now 
treating  her  very  well  and  she  goes  several  times  a  week  to  see  her  mother. 
She  has  not  been  going  out  with  the  boys  any  during  the  summer.  Has  lost 
interest  in  such  matters. 


APPENDIX    A  667 

Patient  is  entirely  friendly  and  is  in  good  spirits  with  the  exception  of 
believing  that  the  matron,  Mrs.  Deneen,  is  not  kindly  disposed  toward  her. 

Foreman,  Mr.  Simpson,  seen  at  Dohertj',  Printers.     It  will  be  best  for 
patient  to  be  away  the  week  of  10/15.     He  cannot  readily  spare  her  for  this 
time,  but  is  willing  to  do  so  in  this  case  of  sickness. 
HA/L 

October  13. 

Patieyit  ivrites  several  times,  last  two  letters  saying  she  has  decided  not 
to  go  to  the  Massachusetts  General  Hospital  for  the  operation,  as  she  has 
gotten  the  impression  from  a  friend  that  this  operation  is  a  reflection  upon 
her  "character  and  her  good  name"  and  will  "go  against  her"  when  she  is 
married.     Patient  says  that  she  intends  to  be  married  soon. 

Patient  seen  at  noon.  Consents  to  go  to  the  hospital  when  nature  of 
operation  is  explained.  Ingram  Stone  wishes  her  to  be  married  soon.  He 
is  a  man  of  35,  unmarried,  and  well  able  to  support  her.  She  ha^  known 
him  since  her  discharge  from  this  hospital  in  1915.  Refused  to  introduce 
him  to  visitor. 
HA/L 

October  15. 

Patient  entered  the  Massachusetts  General  Hospital. 
HA/L 

October  16. 

Mother  seen  at  home.  Patient  has  come  in  to  see  her  every  two  weeks 
or  month  since  last  January.  Last  July  she  paid  $1  for  two  or  three 
weeks,  but  has  not  done  so  at  any  other  time  since  January,  1917.  She  has 
taken  no  meals  at  the  house  with  the  exception  of  one  breakfast.  She  has 
been  fairly  agreeable  and  not  particularly  troublesome.  ^Mother  seems  to 
have  a  better  conception  of  patient's  needs  and  changeableness  than  previ- 
ously, and  to  accept  it  as  part  of  her  character. 
HA/L 

Patient  seen  three  or  four  times,  and  writes.  October  15-21  patient 
was  in  the  jMassachusetts  General  Hospital  for  a  slight  gynecological  opera- 
tion. She  paid  $ig  out  of  her  own  money  for  this.  From  Oct.  21-26  she 
was  at  home,  going  Oct.  26  to  IMarshfield  Hills  (Country  Week  paying 
fares),  to  spend  the  week-end  with  another  patient,  Fern  Linnwood,  a  blind 
woman,  formerly  patient's  roommate.  She  stayed  only  until  the  next  day 
because  of  a  disagreement  with  the  boarding  women.  Fern  later  wrote  a 
disagreeable  letter,  which  has  estranged  patient  from  her.     See  letter. 

Brother  Bernard's  wife  had  him  arrested  for  abuse  and  non-support, 
and  he  was  in  jail  a  night  in  the  end  of  October.  Patient  has  been  much 
upset  over  this.  Agreement  was  made  out  of  Court,  and  they  are  living 
together  again. 

Patient  says  that  in  the  summer  she  went  into  Ukrane's  Cafe,  Pember- 
ton  Square,  and  ordered  a  drink.  The  waiter  was  a  long  time  bringing  it, 
and  patient  saw  one  speak  to  another,  became  suspicious  that  visitor  had 
posted  them  not  to  serve  her,  but  to  get  the  police,  and  left  hurriedly. 
She  will  not  go  back,  and  still  thinks  that  visitor  was  in  there  to  tell  them. 

Patiejit  and  Bertha  Greenwood  (another  Social  Service  case)  go  sev- 
eral nights  a  week  to  a  Soldiers'  Mission  on  Isham  Street. 

November  15. 

Patient's  mother  seen.  She  says  that  when  patient  was  with  them 
everything  went  well.  jMother  was  given  some  army  knitting  to  do,  from 
which  she  is  earning  $2.30.    They  find  it  very  hard  to  make  both  ends  meet. 


668  APPENDIX    A 

1917  .  .  ... 

especially  as  Florence's  sewing  season  is  dull,  and  living  higher.     Mother  is 

not  so  well  lately,  and  has  pains  in  the  side  more  often. 

Patient  seen  four  or  five  times,  writes  and  telephones.  Before  Thanks- 
giving she  drank  something  a  couple  of  times,  but  did  not  tell  visitor  until 
two  weeks  later.  She  is  most  anxious  to  keep  from  it  and  will  turn  to 
some  other  visitor  if  she  needs  assistance  in  doing  so. 

She  crocheted  at  the  Mission,  and  was  criticized  by  one  of  the  men,  so 
that  she  left.  Patient  has  since  been  asked  by  the  Matron,  Mrs.  Mentor,  to 
return.  She  goes  Saturday  and  Sunday  evenings  usually.  Last  Saturday 
she  went  with  another  girl  to  Underwood  Chapel  and  stayed  to  Sunday 
School.  Has  not  been  to  St.  Matthew's  church  for  several  months,  and  no 
one  has  visited  her  from  there,  so  that  she  thinks  that  she  is  not  missed. 

For  the  past  two  weeks,  patient  has  been  around  evenings  with  Fannie 
Olson,  who  rooms  across  from  her.  She  is  a  girl  known  to  Miss  Yonger, 
a  social  worker  in  the  State  House.  Patient  is  afraid  that  she  steals,  so 
she  will  not  go  around  the  shops  with  her.  They  go  to  the  INIission  and 
Underwood  Chapel. 
HMA/A 

November  15. 

Patient's  mother  seen.  She  will  write  the  Social  Service  if  patient  ever 
tries  to  move  home,  or  makes  any  definite  trouble.  She  is  sometimes  dis- 
agreeable to  them,  and  on  several  occasions  has  spoken  to  Florence  on  the 
street.     Her  attitude  is  about  as  usual. 

Brother  Bernard  now  lives  in  Dover,  Mass.,  to  be  nearer  his  employer, 
Introit  Dillingham  Electric  Co.. 

See  letters. 
HA/S 

December  31. 

Case  closed.    Patient  is  doing  well, 
HA/S 

1918 
January  7. 

Rev.  Mr.  Mittelman  seen  at  St.  Matthew's  Church,  Emmons  St.  Visi- 
tor tells  informant  that  patient  had  not  been  going  to  St.  Matthew's  Church 
lately,  but  had  been  going  to  Underwood  Chapel  instead.  Visitor  asked 
informant  if  he  would  call  on  patient  and  get  her  interested  in  some  organ- 
ization. Informant  did  not  remember  patient's  name,  or  know  that  she  was 
a  member  of  his  church.  He  said  he  would  be  glad  to  do  all  he  could  for 
her.  It  was  made  known  to  informant  that  patient  was  a  closed  case  to 
the  hospital. 
SPE/S 

March  12. 

.Case  reopened.  Patient  seen  at  hospital,  said  she  was  still  living  at 
Y.  W.  C.  A.,  68  Warrington  St.,  but  that  she  was  very  anxious  to  move. 
She  is  in  debt  to  Y.  W.  C.  A.  for  back  room  and  board  to  the  extent  of  $16 
or  $17,  and  would  like  to  have  arrangement  made  by  which  she  could  pay 
off  this  debt  by  paying  $1  per  week.  Said  she  had  between  $40  and  $50  in 
the  bank,  but  did  not  want  to  take  any  money  out  as  she  was  afraid  she 
would  never  be  able  to  save  any  more.  Said  she  had  become  very  intimate 
with  a  girl  named  Fannie  Olson,  who  also  lived  at  Y.  W.  C.  A.  Patient  felt 
that  this  girl  had  bad  influence  over  her.  The  girl  steals,  and  spends  a  great 
deal  of  money  for  clothes.  Patient  tries  to  dress  as  well  as  Faimie  Olson 
and  consequently  spends  all  her  money  for  clothes.     It  was  in  this  way  that 


APPENDIX    A  669 

igi8 

patient  ran  u£  bill  at  Y.  W.  C.  A.,  as,  instead  of  paying  for  board  and  room, 
she  spent  the  money  for  clothes. 

Patient  seemed  anxious  to  get  a  furnished  room  and  take  her  meals 
out;  thought  it  would  be  better  for  her  to  live  alone,  for  when  she  lived 
with  other  girls  she  always  got  into  difficulties.  Said  she  had  a  married 
brother,  Benjamin  Farmer,  living  in  North  Dunning.  She  has  always  gotten 
along  with  him,  although  recently  she  has  seen  very  little  of  him._  Did  not 
know  whether  they  would  consider  giving  her  a  home.  Would  like  visitor 
to  see  them  and  will  send  visitor  the  exact  address.  Patient  will  stay  at 
Y.  W.  C.  A.  until  March  16.  Is  still  working  for  Doherty  Printers,  292 
Nottingham  Avenue,  Boston,  earning  $10  a  week. 
MBH/H 

Patient  said  she  did  not  feel  very  well ;  had  had  a  continuous  cold  all 
winter;  said  she  was  still  subject  to  crying  spells. 
MBH/H 

March  13. 

Mrs.  Dawson,  Matron  of  Y.  W.  C.  A.,  telephoned  to.  Said  patient  was 
a  nice,  quiet  girl  who  gave  no  trouble  in  the  house.  Keeps  to  herself  a 
great  deal  and  has  few  friends  in  the  house,  although  she  is  liked  by  every- 
one. To  informant's  knowledge,  patient  has  not  been  drinking,  and  has 
been  home  a  great  deal,  and  has  had  several  crying  spells.  Thought  patient 
was  in  good  condition  physically,  aside  from  a  hard  cold,  which  she  had 
had  all  winter. 

Informant  said  that  patient  and  Fannie  Olson  had  been  very  intimate, 
but  quarreled  about  a  month  ago  when  a  man  who  had  been  going  with 
patient  transferred  his  affections  to  Fannie.  Patient  and  Fannie  have  not 
spoken  since.  Informant  said  Fannie  was  a  very  nice  girl  and  did  not 
believe  patient's  stories  that  Fannie  stole  could  be  true.  Nothing  had 
been  taken  from  the  house,  and  if  Fannie  was  inclined  to  steal  she  would 
have  excellent  opportunity  at  the  house. 

Informant  said  that  patient  owed  Y.  W.  C.  A.  a  little  over  $16.  Visitor 
asked  if  patient  could  pay  this  back  in  installments  of  $1  a  week,  to  which 
informant  readily  agreed.  Visitor  told  informant  that  patient  was  consider- 
ing moving  and  informant  was  sorry  to  hear  this,  as  she  had  enjoyed 
having  patient  in  the  house. 
MBH/H 

March  14. 

Sec  letter  from  patient. 

March  14. 

Inman  House  telephoned  to.     House  is  closing  3/30/18. 

Gordon  House  telephoned  to.     Said  they  would  not  consider  giving 
patient  a  room,  as  she  had  caused  so  much  trouble  when  she  was  there 
formerly. 
MBH/H 

March  15. 

Patient  telephoned  to.  Said  she  had  decided  to  stay  at  Y.  W.  C.  A. 
Told  her  that  arrangement  had  been  made  with  Mrs.  Dawson  by  which 
patient  could  pay  $1  a  week  on  her  back  board.  Patient  agrees  to  do  this 
and  said  she  would  begin  March  16.  Said  she  liked  living  at  Y.  W.  C.  A. 
very  much.  The  only  reason  she  wished  to  move  was  because  she  thought 
Fannie  Olson  had  bad  influence  on  her.  However,  she  has  seen  very  little 
of  Fannie  lately,  so  did. not  feel  it  was  necessary  to  move  in  order  to  get 
away  from  her. 


670  APPENDIX    A 

T919 

Mrs.  Deneen,  M  air  on  Y.  W.  C.  A.,  telephoned  to.    Told  her  that  patient 
had  decided  not  to  move,  and  that  she  would  begin  paying  back  $1  a  week 
on  March  16.     Informant  said  she  was  glad  to  have  patient  stay. 
MBH/H 

April  24. 

Patient  telephoned.  Said  she  had  been  sick  for  a  few  days,  but  was 
now  back  at  work.  Said  everything  was  going  splendidly,  both  at  work 
and  at  the  Y.  W.  C.  A.  Said  she  was  getting  along  well  with  the  other 
girls,  and  seemed  to  be  enjoying  life  very  much.  She  is  paying  every  week 
on  her  back  board  and  now  owes  only  about  $10. 
MBH/H 

April  24.  ^ 

Case  closed. 
MBH/H 

June  9. 

Case  reopened.  Patient  interviewed  at  hospital.  She  came  to  talk  over 
her  job.  She  has  been  working  steadily  at  the  same  job  and  living  in  the 
same  place,  but  has  recently  become  discouraged  because  she  has  had  no 
advancement.  She  feels  that  the  boss  is  hard  on  her  and  gives  her  a  great 
deal  more  difficult  and  a  greater  amount  of  work  than  he  gives  to  the  other 
girls  in  the  same  department  who  have  been  there  a  shorter  time  and  are 
earning  more  money.  Seems  quite  depressed  and  discontented.  Says  that 
it  is  very  difficult  to  get  along  on  her  present  wage,  which  is  still  $10  a 
week. 

Visitor  advises  patient  to  talk  things  over  frankly  with  her  Superin- 
tendent before  giving  up  the  job,  asking  him  what  he  can  do  for  her  and 
calling  to  his  attention  the  fact  of  how  long  she  has  been  there.     Patient 
promises  to  do  this. 
EW/MMM 

June  II. 

Patient  telephones.     States  that  she  has  talked  with  her  Superintendent 
who  could  tell  her  nothing  definite.     Promises  to  see  her  again  on  June  14th 
and  let  her  know  the  result. 
EW/MMM 

June  16. 

Patient  telephones.  Says  that  the  Superintendent  was  very  nice  to  her 
and  that  he  could  not  raise  her  wages  until  fall  at  any  rate  because  the 
work  was  slack  in  the  summer  and  he  had  to  keep  down  expenses.  States 
that  he  intended  to  raise  all  the  girls'  wages  in  the  fall  and  will  raise 
patient's.  Meanwhile  he  gave  her  $6  surplus  and  promised  to  do  what  he 
could  in  this  way  during  the  summer,  also  to  lighten  her  work  somewhat. 
EW/MMM 

June  20. 

Patient  telephones.  Things  have  been  going  fairly  well  as  the  Super- 
intendent has  lightened  her  work  considerably  and  given  the  harder  extra 
work  to  the  other  girls.  She  has  not  had  overtime  work  since  she  spoke  to 
him.  She  has  not  quite  decided  whether  she  will  stay.  Visitor  advises  her 
not  to  be  precipitous  in  any  case.  Patient  promises  to  let  visitor  know 
before  she  changes  her  job,  or  if  she  gets  wind  of  any  other  position. 
EW/MMM 


Form  I 


Name 

Residence 

Correspondent 

Sex 

Civil  condition 

Religion 

Time  in  Boston 

Previous  addresses 


APPENDIX  B 
SOCIAL  SERVICE  FORMS 

PSYCHOPATHIC   HOSPITAL 

SOCIAL   SERVICE 

XCemoraudiuu  Slip 

File  number 
O.  P.  D.  number 


Age  Color 

Place  and  date  of  birth 

Occupation 

In  Mass.  Jn  U.  S. 


Name  and  address  of  father 

Name  and  address  of  mother 

Name  and  address  of  spouse 

Names,  addresses,  and  ages  of  children  or  siblings 

Names  and  addresses  of  relatives  or  friends 


Admitted  to  house 

Discharged 

Diagnosis 

Provisional  diagnosis 

Reason  for  referring  to  Social  Service 

Report  from  the  Confidential  Exchange 


Authority 

Admitted  to  O.  P.  D. 

Examiner 

Date 


Living  conditions  previous  to  admission 


Remarks 


Visitor's  name 
671 


672 


APPENDIX    B 


Form  II 


Name  of  patient 
Date 


PSYCHOPATHIC  HOSPITAL 

SOCIAL   SERVICE 

mqulry  Slip 


CHECK    WHEN 
DONE    WITH 

INITIALS 
OF    VISITOR 


PERSONS    TO   BE    SEEN 
(Give  full  name,  address,  and  relationship  to  patient  here  and  below) 


PERSONS   TO   BE  TELEPHONED  TO 


PERSONS  TO  BE  WRITTEN  TO 


APPENDIX    B 


^7Z 


Form  HI 


PSYCHOPATHIC   HOSPITAL 

SOCIAL    SERVICE 

Outluie  for  History 


Date 

Name 

Address 

Age 

Date  and  place  of  birth 

Religion 

Civil  condition 

Referred  to  hospital  by 
Brought  by 
Reason  for  coming 
History  obtained  by 

Medical  Record  : 

Dates  of  admissions 

Dates  of  discharges 

Summary  of  physical  examination 

Summary  of  mental  examination 

Summary  of  intelligence  tests 

Conduct  on  the  wards 

Diagnosis 

Prognosis 


Social  History; 
Family: 


Father  j 

Mother 

Brothers  and  sisters  ! 

Spouse  I 

Children  ! 


For  each  give 


Date  and  place  of  marriage 
Other  members  of  the  household 
Attitude  of  the  family  toward  patient 
Relatives 


Address 

Age  and  date  of  birth 

Nativity 

Religion 

Time  in  U.  S.,  in  state,  in  city 

Occupation 

Intelligence 

Character 


674  APPENDIX    B 

Social  History  : — Continued 

Friends  and  References: 
Friends,  neighbors 
Doctors,  lawyers,  clergymen 
Institutions,  courts,  social  agencies 
Hospitals 

Work: 

{Progress 
Wages 
Duration  of  the  position 
Character  of  associates 

Recreation: 
Opportunities 
Companions 

Schools  (in  order  in  which  they  were  attended,  with  dates)  : 

Home  and  Neighborhood: 

Character  of  locality  (factory,  business,  tenement,  suburban,  etc.) 

Character  of  street  ^ 

Character  of  building 

Character  of  the  home  I  State  as  far  as  possible  in  specific  term. 

(i)   furnishings 

(2)   neatness  and  cleanlinessj 
Income  and  savings 

Expenses  —  rent,  insurance,  benefit  societies,  etc. 
Attitude  of  family  toward  their  income 

Habits  of  family  in  regard  to  eating  and  sleeping 

Character  of  patient's  bedroom  (sleeps  alone  or  with  whom) 

Character  of  patient's  food 

P  H  VS I C  A  L    H I  STORY  : 

Dcvclopmoital  History: 

Full  term?     Normal  delivery?  \ 

Prenatal  history : 

Work  of  mother  during  pregnancy 

Diseases  of  mother  during  pregnancy 

Injuries  to  mother  during  pregnancy 

Mental  strain  of  mother  during  pregnancy 
Birth  weight 

Feeding  —  breast  or  bottle 
Age  of  sitting  up 
Age  of  first  tooth 
Age  of  creeping 
Age  of  walking 
Age  of  talking 
Age  of  puberty 
Illnesses : 

General 

Convulsions 

Injuries 

Hospital  c^x^ 


APPENDIX    B  675 

Physical  History  : — Continued 

Personal  Hygiene: 

Habits  of  sleeping  (hours) 
Habits  of  eating 
Habits  of  bathing 

Heredity : 

Relationship  between  parents 

Condition  of  health  and  cause  of  death  of — 

Father 

Mother 

Sisters  and  brothers 

Maternal  grandparents 

Paternal  grandparents 

Uncles  and  aunts 
Tuberculosis,  alcoholism,  insanity,  f  eeble-mindedness,  epilepsy,  or  cancer 
Any  mental  or  physical  abnormalities  in  the  family 
Any  exceptional  ability  in  the  family 

Physical  Efficiency: 
Lazy  or  energetic? 
Frail  or  robust? 
How  easily  fatigued? 
Susceptibility  to  pain? 

Mental  History  : 

Education : 

Age  of  going  to  school 

School  record 

Grade  and  age  of  leaving 

Special  t^raining  (industrial,  commercial,  musical,  etc.) 

Reading 

Employment: 

Success  or  failure 

Reasons  for  resignations  or  discharges 

Patient's  trade 

Work  for  which  patient  thinks  he  is  best  fitted 

Dispositicin  and  Character : 
Likes  and  dislikes 
Habits 
Peculiarities 
Special  abilities 

Attitude  of  patient  toward  his  family 
Changes  in  character 
Onset  of  present  trouble 

Summary: 

Social  history 
Physical  history 
Mental  history 


676  APPENDIX    B 

Analysis  of  Social  Symptoms 

Social  Diagnosis 


Recommendations  in  Regard  to- 
Social  condition 
Physical  condition 
Mental  condition 


II 

History  (Interviews) : 
Patient's  Story 

Statements  of  Others  (with  impression  of  informant  at  the  end  of  each 
statement) 


III 

Action  Taken  (Chronological  record). 


SiTMMARY  OF  Results: 

r  Social  condition 
At  the  end  of  every  three  months-<  Physical  condition 

L  Mental  condition 


APPENDIX  C 
LEGISLATION  IN  RELATION  TO  MENTAL  DISEASE 
Frankwood  E.  Williams,  M.D. 

When  hospitals  for  the  insane  were  first  opened  in  this  country, 
admission  to  them  was  as  informal  and  on  the  same  basis  as  ad- 
mission to  any  other  hospital.  Provision  was  made  for  the  com- 
mitment by  courts  of  those  "so  furiously  mad  as  to  be  a  danger 
to  the  community,"  but  patients  who  desired  admission  or  those 
whose  friends  desired  admission  for  them  were  admitted  freely. 

During  the  early  twenties  of  the  nineteenth  century,  public  in- 
terest in  the  care  of  the  insane  was  aroused  and  states  began  to 
build  public  hospitals.  This  interest  had  come  from  England, 
where  it  had  been  shown  that  many  of  the  insane  if  taken  from 
the  almshouses  and  jails,  cages  and  pens,  where  many  of  the 
poorer  were  confined  and  neglected,  and  treated  in  proper  hos- 
pitals, might  be  restored  to  reason.  The  object  in  building  the 
state  hospitals,  therefore,  was  to  provide  this  sort  of  care  for  those 
who  could  not  otherwise  afiford  it.  The  hospitals  were  regarded 
with  great  favor — ^the  "state's  greatest  charity."  It  was  believed 
that  the  earlier  a  patient  could  receive  treatment  the  greater  was 
the  chance  for  his  recovery  and  no  obstacles,  therefore,  were  put 
in  the  way  of  entrance  to  the  hospital.  On  the  contrary,  the 
friends  of  patients,  and  patients  themselves,  were  urged  to  come 
to  the  hospital  as  soon  after  the  first  signs  of  mental  illness  as 
possible;  and  when  they  came  no  question  as  to  admission  was 
raised  except  the  possible  one  of  an  unoccupied  bed. 

This  informality  of  admission  continued,  in  Massachusetts,  for 
example,  for  a  period  of  forty-four  years,  or  from  the  opening  of 
the  McLean  Hospital  in  1818  to  1862  when  a  law  was  passed  re- 
quiring "in  all  cases  the  evidence  and  certificate  of  at  least  two 
reputable  physicians  ...  to  establish  the  fact  of  insanity." 

For  some  thirty  years  the  hospitals  had  held  the  confidence  of 
the  community,  but  in  the  ten  years  previous  to  1862  there  had 
begun  to  develop  a  feeling  first  of  disappointment  and  then  of 
distrust.  The  disappointment  was  more  or  less  warranted  as  the 
hospitals  had  not  been  able  to  bring  about  the  happy  results  the 
community  unfortunately  had  been  led  to  expect;  the  distrust  at 

677 


678  APPENDIX    C 

this  time  was  not  warranted.  Nevertheless,  the  fear  became  more 
or  less  general  that  patients  were  being  wrongfully  detained  in 
hospitals  and  driven  mad  by  their  associates,  that  personal  liberty 
was  becoming  of  little  consequence,  and  even  that  it  might  be 
possible  to  find  two  physicians  who  through  interested  motives 
might  wrongfully  certify  to  insanity,  and  that  a  superintendent 
might  be  bribed  to  keep  the  person  in  confinement.  As  a  result, 
legal  barriers  were  year  by  year  built  about  the  hospitals,  until  by 
1874  the  hospitals  were  almost  completely  isolated  from  the  com- 
munity ;  admission  to  them  was  a  formal  legal  matter  to  be  decided 
by  court  or  jury.  In  consequence,  admission  was  practically  im- 
possible for  patients  in  the  early  stages  of  illness  and  the  hospitals 
became  asylums  for  the  care  of  chronic  patients  about  whose  men- 
tal condition  there  could  be  no  question,  as  it  was  obvious  even  to 
lay  judges  and  juries.^ 

As  the  hospitals  became  more  and  more  asylums  for  chronic 
patients,  interest  in  them  on  the  part  of  the  medical  profession 
lessened  and  the  hospitals  became  the  prey  of  the  politician,  posi- 
tions in  the  hospitals  from  ward  attendant  and  nurse  to  super- 
intendent becoming  the  rightful  spoils  of  successful  candidates  for 
public  office.  This  situation  obtained  for  many  years  and  still 
obtains  in  certain  states. 

Legislatures  that  had  been  so  aroused  against  the  hospitals  in 
1874  had  learned  by  1882  that  they  had  been  badly  advised;  that 
it  was  to  the  interest  neither  of  the  community  nor  the  patient  to 
deny  to  the  patient  the  only  possible  help  there  was  for  him  until 
such  time  as  his  illness  had  become  so  chronic  that  any  hope  that 
there  might  have  been  in  the  first  place  was  largely  lost.  A  period 
of  constructive  legislation  began  about  this  time.  Some  states  still 
have  on  their  statute  books  the  laws  passed  in  this  period  of  dis- 
trust, but  in  the  past  forty  years  many  of  the  states  have  rewritten 
their  "insanity  laws"  and  in  this  rewriting  two  main  objects  have 
been  kept  in  mind — to  remove  the  hospitals  from  the  field  of  po- 
litical spoils  and  to  place  them  in  the  hands  of  reputable  physicians 
whose  qualifications  are  their  professional  skill  and  knowledge  of 
the  special  problems  involved ;  and  to  make  the  hospitals  as  acces- 
sible as  possible  to  those  who  may  need  them  in  order  that  the 
hospitals  may  serve  their  communities  effectively.  This  desire  to 
bring  the  hospitals  back  into  the  communities  as  dynamic  forces  in 
the  interest  of  public  health  has  been  greatly  increased  in  the  past 
few  years  by  the  knowledge  that  has  come  from  medical  and  social 

^  Legislation  for  the  insane  in  Massachusetts  with  particular  reference 
to  the  voluntary  and  temporary  care  laws.  By  Frankwood  E.  Williams, 
M.D.  Boston  Medical  and  Surgical  Journal,  vol.  173,  no.  20,  Nov.  11,  1915. 
Publication  No.  5  of  the  Massachusetts  Society  for  Mental  Hygiene. 


APPENDIX    C  679 

investigations  showing  the  relationship  that  frequently  exists  be- 
tween mental  disease  and  defect  and  asocial  conduct  and  likewise 
by  medical  research  that  has  made  possible  a  clearer  conception  of 
the  nature  of  mental  disease  and  indicated  means  by  which  such 
disease  may  be  not  only  cured  but  avoided.  The  barriers,  there- 
fore, that  had  unwisely  been  built  about  the  hospitals  until  their 
usefulness  had  been  largely  destroyed  are  now  being  rapidly  re- 
moved and  the  hospitals  from  being  institutions  of  horror  are 
becoming  institutions  of  hope ;  professional  skill  of  a  very  special 
kind  instead  of  being  locked  inert  within  hospital  walls  is  being 
brought  through  out-patient  departments  and  social  service  depart- 
ments out  into  the  community  where  it  can  be  of  great  service; 
and  the  community  instead  of  drawing  away  in  fear  is  seeking 
from  the  hospitals  advice  both  in  personal  and  community  matters. 

This  development  has  been  slow,  although  more  rapid  of  recent 
years,  and  has  developed  differently  and  at  a  different  pace  in 
different  states  so  that  one  may  now  find  in  this  country  an  illus- 
tration of  almost  any  stage  from  the  more  or  less  completely 
isolated  and  politically  controlled  asylum  of  the  sixties  and  seven- 
ties to  the  most  modern  type  of  hospital  scientifically  equipped  and 
staffed,  with  its  social  service  and  out-patient  departments  radiat- 
ing to  all  points  in  its  locality  and  its  advice  sought  on  many  dif- 
ferent matters. 

In  bringing  about  this  accessibility  of  the  hospitals  three  laws 
have  been  found  particularly  useful.  These  are  known  as  the 
Voluntary  Care,  the  Temporary  Care,  and  the  Observation  Laws. 
In  Massachusetts  a  fourth  law,  known  as  the  Boston  Police  Law, 
has  been  found  very  useful. 

Provision  for  the  reception  of  voluntary  patients  in  state  and 
private  hospitals  has  been  made  in  the  following  twenty-nine  states : 
California,  Colorado,  Connecticut,  Georgia,  Illinois,  Indiana, 
Kansas,  Maine,  Maryland,  Massachusetts,  Michigan,  Minnesota, 
Mississippi,  Missouri,  New  Hampshire,  New  Jersey,  New  York, 
North  Carolina,  Ohio,  Oklahoma,  Oregon,  Pennsylvania,  Rhode 
Island,  South  Carolina,  South  Dakota,  Vermont,  Virginia,  West 
Virginia,  and  Wisconsin. 

The  law  ususally  provides  that  the  patient  must  sign  an  appli- 
cation for  admission,  that  his  mental  condition  must  be  such  that 
he  can  understand  the  nature  of  this  request  as  well  as  the  need 
of  treatment,  and  that  he  must  be  released  on  a  demand  in  writing 
in  from  three  to  seven  days  after  such  application.  In  the  case  of 
six  of  these  states  his  request  for  admission  must  be  accompanied 
by  the  certificate  of  one  or  two  physicians,  and  in  some  instances 
his  application  must  be  signed  in  the  presence  of  a  physician. 

Fifteen  states  and  the  District  of  Columbia  have  laws  authoriz- 


68o  APPENDIX    C 

ing  commitment  for  temporary  care  and  observation.  They  are 
Connecticut,  Illinois,  Maine,  Massachusetts,  Michigan,  Minnesota, 
New  Jersey,  New  York,  North  Carolina,  Oklahoma,  Pennsylvania, 
South  Carolina,  Tennessee,  Washington,  and  Wisconsin/ 

The  best  examples  of  Temporary  Care  Laws  are  probably  those 
of  Massachusetts,  and  they  may  well  be  used  as  illustrations  here. 
Aside  from  the  law  permitting  voluntary  admission,  Massachusetts 
has  three  laws  that  make  it  possible  for  a  patient  to  obtain  hospital 
care  and  treatment  without  formal  court  procedure  and  a  fourth 
law  under  which  the  legal  formalities  are  slight. 

1,  Temporary  Care  Law  (Chapter  174,  Acts  1915).  This  law 
provides  that  a  superintendent  may,  when  requested  by  a  physi- 
cian, by  a  member  of  the  board  of  health  or  a  police  officer  of  a 
city  or  town,  by  an  agent  of  the  institutions-registration  depart- 
ment of  the  city  of  Boston,  or  by  a  member  of  the  district  police, 
receive  and  care  for  in  such  hospital  as  a  patient  for  a  period  not 
exceeding  ten  days,  any  person  who  needs  immediate  care  and 
treatment  because  of  mental  derangement  other  than  delirium  tre- 
mens or  drunkenness.  Such  patients  are  received  on  application 
in  writing  filed  at  the  time  of  reception  of  the  patient  or  within 
twenty-four  hours  thereafter  and  must  be  discharged  or  com- 
mitted within  ten  days  unless  they  make  a  request  for  voluntary 
care.  This  law  is  useful  both  as  an  emergency  law  and  as  an 
observation  law  as  under  it  physicians  may  bring  to  the  hospital 
for  examination  and  advice  patients  about  whose  condition  they 
have  reason  to  be  concerned,  but  whom  they  do  not  sufficiently 
understand  to  warrant  a  formal  application  for  commitment  as 
insane  or  those  patients  who,  although  clearly  "insane"  in  a  medical 
sense,  are  in  such  an  early  stage  of  their  illness  that  a  formal 
commitment  would  not  be  possible.  Treatment  is  therefore  pro- 
vided at  a  time  when  it  is  likely  to  be  of  greatest  help,  but  which 
could  not  be  obtained  except  for  the  provisions  of  this  law.  The 
value  of  the  law  as  an  aid  in  restoring  health  and  preventing 
chronic  illness  can  scarcely  be  overestimated. 

2.  Emergency  Laiv  (Section  42,  Chapter  504,  Acts  1909).  The 
superintendent  of  a  hospital  may  receive  and  detain,  for  not  more 
than  five  days  without  a  court  order,  any  person  "certified  to  be 
one  of  violent  and  dangerous  insanity  or  of  other  emergency"  by 
two  qualified  medical  examiners.  Officers  authorized  to  serve 
criminal  processes,  or  police  officers,  must,  on  the  request  of  the 
applicant  or  one  of  the  examining  physicians,  bring  such  a  person 
to  the  hospital.  The  applicant  for  this  form  of  admission  must 
within  five  days  arrange  for  the  commitment  of  the  person  so 

*Laws  controlling  commitments  to  state  hospitals  for  mental  diseases, 
by  James  V.  May,  M.D.,  Menial  Hygiene,  vol.  5,  no.  3,  July,  1921. 


APPENDIX    C  68 1 

received,  or  for  his  removal  from  the  hospital.  This  law  makes  it 
unnecessary  in  an  emergency  to  "arrest"  a  sick  individual  as  a 
criminal  and  confine  him  in  a  local  jail  until  such  time  as  it  may 
be  possible  to  bring  him  before  a  court  for  commitment.  Courts 
are  frequently  not  in  session  at  the  time  an  individual  becomes  ill. 
When  holidays  fall  at  the  end  or  the  beginning  of  the  week  there 
may  be  several  days  without  a  session  of  the  court.  Through  the 
provisions  of  this  law,  the  patient  may  be  brought  at  once  to  the 
hospital  where  he  can  be  properly  cared  for  until  such  time  as  the 
court  may  convene. 

3.  Observation  Law  (Chapter  145,  Acts  1919).  A  person 
found  by  two  qualified  examiners  to  be  in  such  mental  condition 
that  his  commitment  to  a  hospital  is  necessary  for  his  proper  care 
or  observation  may  be  committed  to  a  state  hospital  for  a  period 
of  thirty-five  days  pending  the  determination  of  his  insanity.  This 
law  is  particularly  useful  in  legal  and  criminal  proceedings  in 
which  the  question  of  mental  condition  is  raised.  It  is  useful  also 
in  difficult  cases  in  which  more  time  is  needed  for  a  determination 
of  the  patient's  mental  condition  than  is  provided  in  the  Temporary 
Care  Law. 

4.  Boston  Police  Law  (Chapter  307,  Acts  1910).  Under  the 
provisions  of  this  law  all  persons  sufifering  from  "delirium,  mania, 
mental  confusion,  delusions,  or  hallucinations  under  arrest  or  who 
come  under  the  care  or  protection  of  the  police  of  the  city  of 
Boston,  shall  be  taken  to  the  Boston  Psychopathic  Hospital  in  the 
same  manner  in  which  persons  afflicted  with  other  diseases  are 
taken  to  a  general  hospital."  Cases  sufifering  from  delirium  tre- 
mens or  drunkenness  may  be  refused  by  the  hospital  authorities ; 
otherwise  all  such  persons  are  admitted,  observed  and  cared  for 
until  they  can  be  committed  or  admitted  to  the  hospital  or  insti- 
tution appropriate  in  each  particular  case  unless  the  patient  re- 
covers or  is  discharged.  Chapter  394  of  the  Acts  of  191 1  is  com- 
plementary to  the  above  in  that  it  provides  that  no  person  suffering 
from  insanity,  mental  derangement,  delirium,  or  mental  confusion, 
except  delirium  tremens  or  drunkenness,  shall,  except  in  an  emer- 
gency, be  placed  or  detained  in  a  lockup,  police  station,  city  prison, 
house  of  detention,  jail  or  other  penal  institution  or  place  for  the 
detention  of  criminals.  If,  in  case  of  emergency,  any  such  person 
is  so  placed  or  detained,  he  shall  forthwith  be  examined  by  a  physi- 
cian and  shall  be  furnished  suitable  medical  care  and  nursing  and 
shall  not  be  detained  for  more  than  twelve  hours.  In  Boston  these 
patients  are  sent  to  the  Psychopathic  Hospital.  In  other  parts  of 
the  state  they  are  cared  for  by  the  board  of  health  of  the  city  or 
town  in  question  until  they  can  be  admitted  to  a  state  hospital  or 
cared  for  by  relatives  or  friends. 


682  APPENDIX    C 

A  very  considerable  use  of  the  voluntary  and  temporary  care 
laws  is  made  in  Massachusetts.  In  fact,  the  temporary  care  laws 
have  very  largely  determined  the  legal  status  of  patients  admitted 
to  the  Boston  Psychopathic  Hospital.  During  a  period  of  six 
years,  6,499  patients,  57.5  per  cent  of  all  admissions,  were  ad- 
mitted under  the  "ten-day"  temporary  care  law.  Nine  thousand 
and  seventy-four,  or  80.3  per  cent  of  the  total  number  of  admis- 
sions during  the  same  period,  were  temporary-care  patients  of  one 
kind  or  another.  The  voluntary  patients  represented  1 7.6  per  cent 
of  the  11,289  patients  during  the  period.^ 

At  the  request  of  the  Surgeon  General  of  the  United  States 
Army,  who  during  the  war  found  embarrassing  the  lack  of  uni- 
formity in  the  various  state  commitment  laws,  the  National  Com- 
mittee for  Mental  Hygiene  appointed  in  1919  a  special  committee 
to  make  a  study  of  the  various  state  laws  and  to  recommend  such 
provisions  as  it  seemed  desirable  to  incorporate  in  a  modern  com- 
mitment law.  The  committee  was  composed  of  Dr.  George  M. 
Kline,  Commissioner,  Massachusetts  State  Department  of  Mental 
Disease ;  Dr.  Charles  W.  Pilgrim,  Chairman  of  the  New  York 
State  Hospital  Commission ;  Dr.  Owen  Copp,  Superintendent, 
Pennsylvania  Hospital,  Department  for  Nervous  and  Mental  Dis- 
eases; Dr.  Frank  P.  Norbury  of  the  Board  of  Public  Welfare 
Commissioners  of  Illinois ;  and  Major  Frankwood  E.  Williams  of 
the  Office  of  the  Surgeon  General,  Washington,  D.  C.  The 
committee  recommended  in  its  report  voluntary  commitment,  tem- 
porary care,  emergency  commitment,  and  commitment  for  obser- 
vation. 

*  Laws  controlling  commitments  to  state  hospitals  for  mental  diseases, 
by  James  V.  Aiay,  M.D.,  Menial  Hygiene,  vol.  5,  no.  3,  July,  1921. 


BIBLIOGRAPHY 


Abbott,  Edith  and  Breckinridge,  Sophonisba.  "The  Delinquent 
Child  and  the  Home."  New  York,  Russell  Sage  Foundation, 
1912. 

Addams,  Jane.  "The  Spirit  of  Youth  and  the  City  Streets."  New 
York,  The  Macmillan  Company,   1914. 

Abler,  Herman  M.  "Cook  County  and  the  Mentally  Handicapped. 
A  Study  of  the  Provisions  for  Dealing  with  Mental  Problems 
in  Cook  County,  111."  New  York,  National  Committee  for  Men- 
tal Hygiene,  1918.     Publication  13. 

.     "A  Psychiatric  Contribution  to  the  Study  of  Delinquency," 

Journal  of  the  American  Institute  of  Criminal  Law  and  Crimin- 
ology, May,  19 1 7. 

"Unemployment  and  Personality:     A  Study  of  Psychopathic 


Cases,"  Mental  Hygiene,  v.  i,  pp.  16-24,  January,  1917. 
— .     "Medical  Science  and  Criminal  Justice."     Section  5  of  Re- 
port of  the  Cleveland  Foundation's  Survey  of  Criminal  Justice. 
Cleveland,  1922. 
-.    "Organization  of  Psychopathic  Work  in  the  Criminal  Courts," 


Journal  of  the  American  Institute  of  Criminal  Lazv  and  Criminr 
ology,  v.  8,  pp.  362-374,  iQi?- 

American  Academy  of  Political  and  Social  Science  Annals,  v.  72, 
whole  no.  166,  March,  1918.  Social  Work  in  Families.  Edited 
by  Frank  D.  Watson. 

Anderson,  V.  V.  "Mental  Disease  and  Delinquency :  A  Report  of 
a  Special  Committee  of  the  New  York  State  Commission  on 
Prisons,"  Mental  Hygiene,  v.  3,  pp.   177-198,  April.   1919. 

Bacon,  Francis.  "Novum  Organum:  or  True  Suggestions  for  the 
Interpretation  of  Nature."     London,  Routledge.  1893. 

Ball,  Jau  Don.  "Correlation  of  Neurology,  Psychiatry,  Psychology, 
and  General  Medicine  as  Scientific  Aids  to  Industrial  Efficiency," 
American  Journal  of  Insanity,  v.  75,  pp.  521-55,  April,  1919. 

Barker,  Lewellys  F.  "The  First  Ten  Years  of  the  National 
Committee  for  Mental  Hygiene,  With  Some  Comments  on  its 
Future,"  Mental  Hygiene,  v.  2,  No.  4,  pp.  557-58i,  October,  1918. 

Beisser,  Paul  T.  "Social  Work :  An  Outline  of  Its  Professional  As- 
pects." New  York,  American  Association  of  Social  Workers, 
1922. 

68^ 


684  BIBLIOGRAPHY 

Bernheim^  Hippolyte.  "Suggestive  Therapeutics :  A  Treatise  on  the 
Nature  and  Uses  of  Hypnotism."  Translated  by  Christian  A. 
Herter.     New  York,  G.  P.  Putnam's  Sons,  1895. 

Beveridge,  William  H.  "Unemployment:  A  Problem  of  Industry." 
London,  Longmans,  Green  &  Company,  1912. 

Bingham,  Anne  T.  "The  Personal  Problems  of  a  Group  of  Work- 
ers," Proceedings  of  the  National  Conference  of  Social  Work, 
1920. 

BoGARDus^  Emory  S.  "History  of  Social  Thought."  Los  Angeles, 
University  of  Southern  California  Press,   1922. 

.  "Problems  in  Teaching  Sociology,"  Journal  of  Applied  So- 
ciology,   V.    6,    No.    2,    pp.    19-24,    December,    1921. 

BosANQUET,  Helen.  "The  Family."  London,  The  Macmillan  Com- 
pany, 1906. 

Breckinridge,  Sophonisba  P.  and  Abbott,  Edith.  "The  Delin- 
quent Child  and  the  Home."  New  York,  Russell  Sage  Founda- 
tion, 19 1 2. 

Briggs,  L.  Vernon.  "The  History  of  the  Psychopathic  Hospital 
of  Boston,  Massachusetts."     (To  be  published.) 

.      "The    Manner    of    Man    That    Kills :      Spencer — Czolgosz- 

Richeson."     Boston,  Badger,  1921. 

Brill,  A.  A.  "Fundamental  Conceptions  of  Psychoanalysis."  New 
York,  Llarcourt,  Brace  &  Company,  1921. 

Bristol,  Lucius  Moody.  "Social  Adaptation :  A  Study  in  the 
Development  of  the  Doctrine  of  Adaptation  as  a  Theory  of 
Social  Progress."     Cambridge,  Harvard  University  Press,   1915. 

Bronner,  Augusta  F.  "A  Method  of  Case  Presentation,"  The 
Family,  v.  3,  pp.  37-48,  April.  1922. 

.     "Psychology  of  Special  Abilities  and  Disabilities."     Boston, 

Little,   Brown  &  Company,   1917. 

Bronner,  Augusta  F.  and  Healy,  William.  "Case  Studies."  Series 
of  twenty.     Boston,  Judge  Baker  Foundation,  1922. 

Brown,  Mabel  W.  and  Williams,  Frankwood  E.  "Neuropsy- 
chiatry and  the  War :  A  Bibliography  with  Abstracts."  New 
York,  National  Committee  for  Mental  Hygiene,  1918. 

Burgess,  Ernest  W.  and  Park,  Robert  E.  "Introduction  to  the  Sci- 
ence of  Sociology."     Chicago,  University  of  Chicago  Press,  1922. 

Burnham,  William  H.  "Health  Examination  at  School  Entrance," 
Journal  of  the  American  Medical  Association,  v.  68,  pp.  893-899, 
March  24,  1917.  Massachusetts  Society  for  Mental  Hygiene, 
Publication  27. 

.  "The  Significance  of  the  Conditioned  Reflex  in  Mental  Hy- 
giene," Mental  Jiygicne,  v.  5,  pp.  673-706,  October,  1921. 

■ .     "Success   and   Failure   as   Conditions   of   Mental    Health," 


Mental  Hygiene,  v.  3,  pp.  387-397,  July,  1919. 


BIBLIOGRAPHY  685 

Byington^  Margaret  F.  "The  Confidential  Exchange :  A  Form  of 
Social  Cooperation."     New  York,  Russell  Sage  Foundation,  1912. 

.      "What   Social   Workers   Should   Know   About   Their   Own 

Communities,"  3rd  edition.  New  York,  Russell  Sage  Founda- 
tion, 1916. 

Cabot,  Richard  C.  "Social  Service  and  the  Art  of  Healing."  New 
York,  Moffat,  Yard  &  Company,  1909. 

.     "Social  Work :     Essays  on  the  Meeting-Ground  of  Doctor 

and   Social  Worker."     New  York,   Houghton,   Mifflin  Company, 

1919- 

"Some  Functions  of   Social   Work   in  Hospitals,"  Modern 


Hospital,  V.  4,  pp.   188-191,  March,  1915. 
Campbell,    C.   Macfie.      "Experiences   of   the    Child:      How   They 

Affect  Character  and  Behavior,"  Mental  Hygiene,  v.  4,  pp.  312- 

319,  April,  1920. 
.     "Mental   Health  of  the   Community   and  the   Work  of  the 

Psychiatric    Dispensary,' '   Mental  Hygiene,   v.    i,   pp.    572-584, 

October,   19 17. 

"Nervous  Children  and  Their  Training,"  Mental  Hygiene, 


V.  3,  pp.   16-23,  January,   1919. 
.  "Psychiatric  Contribution  to  Educational  Problems,"  Trans- 
actions of  the  Fourth  International  Congress  on  School  Hygiene, 

1913- 

Cannon,  Ida  M.  "Social  Work  in  Hospitals."  New  York,  Russell 
Sage  Foundation,  1913. 

Cannon,  M.  Antoinette.  "Health  Problems  of  the  Foreign  Born 
from  the  Point  of  View  of  the  Hospital  Social  Worker,"  Pro- 
ceedings of  the  National  Conference  of  Social  Work,  1920. 

Cannon,  Walter  B.  "Bodily  Changes  in  Pain,  Hunger,  Fear,  and 
Rage:  An  Account  of  Recent  Researches  into  the  Function  of 
Emotional  Excitement."  New  York,  D.  Appleton  and  Company, 
1920. 

Carver,  Thomas  Nixon.  "Essays  in  Social  Justice."  Cambridge, 
Harvard  University  Press.  19 15. 

.    "Sociology  and  Social  Progress."     Boston,  Ginn  &  Company, 

1905. 

Chapin,  F.  Stuart.  "Field  Work  and  Social  Research."  New  York, 
The  Century  Co.,  1920. 

Clark,  L.  Pierce.  "Treatment  of  the  Epileptic  Based  on  a  Study 
of  Fundamental  Make-up,"  Journal  of  American  Medical  Asso- 
ciation, v.  70,  pp.  357-362,  February  9,  1918. 

Cleveland  Foundation.  Report  of  Survey  of  Criminal  Justice  di- 
rected by  Roscoe  Pound  and  Felix  Frankfurter.     Cleveland,  1922. 

Cobb,  Stanley.  "Applications  of  Psychiatry  to  Industrial  Hygiene," 
Journal  of  Industrial  Hygiene,  v.  i,  pp.  343-347,  November,  1919. 


686  BIBLIOGRAPHY 

CoLCORD^  Joanna  C.  "Broken  Homes:  A  Study  of  Family  Deser- 
tion and  Its  Social  Treatment."  New  York,  Russell  Sage  Foun- 
dation,   1919. 

Copp,  Owen.  "Community  Organization  for  Mental  Hygiene,"  Pro- 
ceedings of  National  Conference  of  Social  Work,  1917. 

Curtis,  Hannah.  "Functions  of  Social  Service  in  State  Hospitals," 
Boston  Medical  and  Surgical  Journal,  v.  175,  pp.  271-275,  August 
24,  igi6.  Reprinted  by  Massachusetts  Society  for  Mental  Hy- 
giene. 

Cutler,  James  Elbert.  "Training  for  Social  Work :  The  Cor- 
relation of  the  Profession  of  Social  Work  and  the  University 
in  the  Control  of  Training  Schools."  Published  by  School  of 
Applied  Social  Sciences,  Western  Reserve  University,  Cleveland. 
Address  at  the  meeting  of  the  Association  of  Training  Schools 
for  Professional  Social  Work,  Pittsburgh,  December  30,  192 1. 

Davis,  Michael  M.  and  Warner,  Andrew  R.  "Dispensaries  :  Their 
Management  and  Development."  New  York,  The  Macmillan 
Company,    191 8. 

Dercum,  Francis  Xavier.  "A  Clinical  Manual  of  Mental  Diseases," 
2nd  edition,   revised.     Philadelphia,  W.  B.   Saunders  Company, 

1917- 

.      "Rest,    Mental    Therapeutics,    Suggestion."      Philadelphia, 

Blakiston's  Son  &  Company,  1903. 

Dewey,  John.  "Human  Nature  and  Conduct.  An  Introduction 
to  Social  Psychology."  New  York,  Henry  Holt  &  Company, 
1922. 

Dewey,  John,  and  Tufts,  James  H.  "Ethics."  New  York,  Henry 
Holt  &  Company,  1908. 

Donohoe,  Marie  L.  "A  Social  Service  Department  in  a  State  Hos- 
pital," Mental  Hygiene,  v.  6,  No.  2,  pp.  306-311,  April,  1922. 

Eder,  M.  D.  "War  Shock."  Philadelphia,  Blakiston's  Son  &  Com- 
pany, 19 18 

Elwood,  Charles  A.  "Sociology  in  its  Psychological  Aspects,"  2nd 
edition.     New  York,  D.  Appleton  &  Company,  1915. 

Emerson,  Charles  P.  "Essentials  of  Medicine :  A  Textbook  of 
Medicine  for  Students  Beginning  a  Medical  Course,  for  Nurses, 
and  for  Mothers  Interested  in  the  Care  of  the  Sick,"  3rd  edition. 
Philadelphia,  Lippincott  Company,  191 5. 

Emerson,  Haven.  "The  Place  of  Mental  Hygiene  in  the  Public 
Health  Movement,"  Mental  Hygiene,  v.  6,  No.  2,  pp.  225-233, 
April,  1922. 

The  Family  (monthly).  New  York,  American  Association  for  Or- 
ganizing Family  Social  Work,  March,  1920 — date. 

Farmer,  Gertrude.  "A  Form  of  Record  for  Hospital  Social  Work." 
Philadelphia,  Lippincott  Company,  1921. 


BIBLIOGRAPHY  68/ 

Fernald,  Walter  E.  "Burden  of  Feeble-mindedness."  Bos- 
ton, Massachusetts  Society  for  Mental  Hygiene,  1912.  Publi- 
cation 4. 

.     "Growth  of  Provision  for  the  Feeble-minded  in  the  United 

States,"  Mental  Hygiene,  v.  i,  pp.  34-57,  January,  1917. 

.  "An  Out-patient  Clinic  in  Connection  with  a  State  Institu- 
tion for  the  Feeble-minded,"  Mental  Hygiene,  v.  4,  pp.  848-856, 
April,  1917. 

.      "Standardized    Fields    of    Inquiry    for    Clinical    Studies    of 

Borderline  Defectives,"  Mental  Hygiene,  v.  i,  pp.  211-234,  April, 
1917. 

.     "State  Program  for  the  Care  of  the  Mentally  Defective," 

Mental  Hygiene,  v.  3,  pp.  566-574,  October,   1919. 

"What  is  Practicable  in  the  Way  of  Prevention  of  Mental 


Defect,"  Proceedings  of  National  Conference  of  Social  Work, 

1918. 
Fisher,  Boyd.    "Has  Mental  Hygiene  a  Practical  Use  in  Industry?" 

Mental  Hygiene,  v.  5,  pp.  479-496,  July,  1921. 
Flesner,  Abraham.     "Is  Social  Work  a  Profession?"    Proceedings 

of  the  National  Conference  of  Social  Work,  1915. 
.     "Medical  Education  in  the  United  States  and  Canada :     A 

Report   to   the   Carnegie   Foundation    for  the   Advancement   of 

Teaching."     New  York,  1910. 
TocH,  Ferdinand.     "The  Principles  of  War."     New  York,  H.  K. 

Fly  Company,   19 18. 
Frankfurter,   Felix.      "Social   Work   and   Professional   Training." 

Proceedings  of  the  National  Conference  of  Social  Work,  1915. 
Frazer,  J.  G.    "The  Golden  Bough :    A  Study  in  Magic  and  Religion," 

3rd  edition,    7  pts.  in  12  vols.     London,  Macmillan  &  Company, 

1911-15. 
Frink,  H.  W.    "Morbid  Fears  and  Compulsions :    Their  Psychology 

and    Psychoanalytic    Treatment."      New    York,    Moffat   Yard   & 

Company,  1918. 
Gage,  Harriet.     "Place  of  Psychiatric  Social  Work  in  the  Social 

Service  Field,"  Hospital  Social  Service,  v.  4,  pp.  143-149,  Sep- 
tember, 1921. 
Gesell,  Arnold.     "Mental  Hygiene  and  the  Public  School,"  Mental 

Hygiene,  v.  3,  pp.  4-10,  January,  1919. 
GiLLiN^   John    Lewis.      "Poverty   and   Dependency:     Their   Relief 

and  Prevention."     New  York,  The  Century  Company,   1921. 
Glueck,   Bernard.      "Concerning    Prisoners,"   Mental   Hygiene,   v. 

2,  PP-  177-218,  April,  1918. 
.     "Recent  Progress  in  Determining  the  Nature  of  Crime  and 

the    Character   of    Criminals,"   National    Conference    of   Social 

Work,  1 91 7. 


688  BIBLIOGRAPHY 

Glueck,  Bernard.     "Special  Preparation  of  the  Psychiatric  Social 
Worker,"  Mental  Hygiene,  v.  3,  pp.  409-419,  July,  1919. 

.     "Studies   in   Forensic   Psychiatry."     Boston,   Little,   Brown 

&  Company,   1916.     Criminal   Science   Monograph  2. 

"Types  of  Delinquent  Careers,"  Mental  Hygiene,  v.   i,  pp. 


171-195,  April,   1917. 

GoDDARD_,  Henry  H.  "Feeble-mindedness :  Its  Causes  and  Conse- 
quences."    New  York,  The  Macmillan  Company,   1914. 

.  "Human  Efficiency  and  Levels  of  Intelligence."  Prince- 
ton, Princeton  University  Press,   1920. 

GoLDMARK,  Josephine  C.  "Fatigue  and  Efficiency:  A  Study  in 
Industry,"  3rd  edition.     New  York,  Survey  Associates,   191 3. 

Gross,  H.  J.  A.  "Criminal  Psychology :  A  Manual  for  Judges, 
Practitioners,  and  Students."  Boston.  Little,  Brown  &  Com- 
pany, 1911. 

Hale,  Dorothy  Q.  "Inadequate  Social  Examinations  in  Psycho- 
pathic Clinics,"  Mental  Hygiene,  v.  5,  pp.  794-806,  October,  1921. 

Hall,  G.  Stanley.  "Adolescence."  New  York,  D.  Appleton  & 
Company,  1904. 

Hart,  Bernard.  "Psychology  of  Insanity."  New  York,  Putnam's 
Sons,  1914. 

Hayes,  Elizabeth  C.  "Case  Correspondence :  A  Method  of  Psy- 
chiatric Social  Work,"  Mental  Hygiene,  v.  6,  pp.  125-155,  Janu- 
ary, 1922. 

Healy,  William.  "Honesty:  A  Study  of  the  Causes  and  Treat- 
ment of  Dishonesty  Among  Children."  Indianapolis,  Bobbs- 
Merrill  Co.,  1915. 

.      "The    Individual    Delinquent :      A    Test-book   of    Diagnosis 

and  Prognosis  for  All  Concerned  in  Understanding  Offenders." 
Boston,  Little,  Brown  &  Company,   191 5. 

,     "Mental  Conflicts  and  Misconduct."     Boston,  Little,  Brown 

&  Company,  1917. 

.  "The  Practical  Value  of  Scientific  Study  of  Juvenile  Delin- 
quents."    Washington,  U.  S.  Children's  Bureau,  1922. 

"Psychiatry,  Psychology,  Psychologists,  Psychiatrists,"  Men- 


tal Hygiene,  v.  6,  No.  2,  pp.  248-256,  April,  1922. 
Healy,  William  and  Bronner,  Augusta  F.    "Case  Studies."    Series 

of  twenty.     Boston,  Judge  Baker  Foundation,  1922. 
Henry,  Edna  G.     "The  Sick,"  Annals  of  the  American  Academy  of 

Political  and  Social  Science,  v.  yy,  pp.  45-59,  May,  1918. 
HocH,  August  and  Amsden,  George  S.    "A  Guide  to  the  Descriptive 

Study  of  the  Personality."     New  York  State  Hospital  Bulletin, 

November,    1913. 
Hocking,  William  Ernest.     "Human  Nature  and  its  Remaking.'" 

New  Haven,  Yale  University  Press,  1918. 


BIBLIOGRAPHY  689 

HoLLiNGwoRTH,  H.  L.  "Vocational  Psychology:  Its  Problems  and 
Methods."     New  York,  D.  Appleton  &  Company,  1916. 

James,  William.  "Psychology."  New  York,  Henry  Holt  &  Com- 
pany, 1892. 

.      "The    Varieties    of    Religious    Experie^ice :      A    Study    in 

Human  Nature."     New  York,   Longmans,   Green   &   Company, 
1902. 

Jarrett^  Mary  C.  "Applications  of  Sociology  in  Psychiatry."  Chap. 
10  of  "Manual  of  Psychiatry,"  edited  by  A.  J.  Rosanoff.  New 
York,  Wiley  &  Sons,   1920. 

.  "Function  of  the  Social  Service  of  the  Psychopathic  Hos- 
pital, Boston,"  Boston  Medical  and  Surgical  Journal,  v.  170,  pp. 
987-993,  June  25,  1914. 

.  "Further  Notes  on  the  Economic  side  of  Psychopathic  So- 
cial Service,"  Boston  Medical  and  Siirgical  Journal,  v.  171,  pp. 
852-854,  December  3,  19 14. 

.    "Intensive  Group  of  Social  Service  Cases,"  Boston  Medical 

and  Surgical  Journal,  v.  175,  pp.  824-830,  December  7,  1916. 

.      "Mental    Hygiene    of    Industry :      Report    of    Progress    on 

Work   Undertaken  under  the   Engineering  Foundation  of   New 
York,"  Mental  Hygiene,  v.   14,  No.  4,  October,  1920. 

.     "Possibilities  in  Social  Service  for  Psychopathic  Patients," 

Boston  Medical  and  Surgical  Journal,  v.  176,  pp.  201-204,  Feb- 
ruary 8,  1917. 

' .     "Psychiatric  Social  Work,"  Mental  Hygiene,  v.  2,  pp.  283- 

290,  April,  1918. 

.      "Psychiatric   Thread    Running   Through   All    Social    Case 

Work,"  Mental  Hygiene,  v.  3,  pp.  210-219,  April,  1919. 

.     "The  Psychopathic  Employee :     A  Problem  of  Industry," 

Medicine  and  Surgery,  v.  i,  pp.  727-741,  September,  1917. 

.     "Shell-Shock  Analogues :     Neuroses  in  Civil  Life  Having 

a  Sudden  or  Critical  Origin,"  Medicine  and  Surgery,  v.  2,  pp. 
266-280,  March,  1918. 

.  "The  Significance  of  Psychiatric  Social  Work,"  Mental  Hy- 
giene, V.   5,  pp.   509-518,  July,   1921. 

"War  Neuroses  After  the  War:     Extra-Institutional  Prep- 


aration," Proceedings  of  National  Conference  of  Social  Work, 
1918. 

Jelliffe,  S.  E.,  and  White,  W.  A.  "Diseases  of  the  Nervous  Sys- 
tem: A  Text-book  of  Neurology  and  Psychiatry,"  2nd  edition, 
revised  and  enlarged.     Philadelphia,  Lea  and  Febiger,  1917. 

Jung,  C.  G.  "Psychology  of  the  Unconscious."  Authorized  trans- 
lation.    New  York,  Moffat,  Yard  &  Company,  1916. 

Kammerer,  Percy  G.  "The  Unmarried  Mother:  A  Study  of  Five 
Hundred  Cases."     Boston,  Little,  Brown  &  Company,   1918. 


690  BIBLIOGRAPHY 

Kellog,  Theodore  H.  "A  Text-Book  of  Mental  Diseases."  New 
York,  1897. 

Kempf,  E.  J.  "Autonomic  Functions  of  the  Personality."  New  York, 
Nervous  and  Mental  Disease  Publishing  Company,  1918. 

Kimball,  Everett.  "The  National  Government  of  the  United  States." 
Boston,  Ginn  &  Company,   1920. 

.     "State   and   Municipal   Government  in  the   United   States." 

Boston,  Ginn  &  Company,   1922. 

King,  W.  L.  Mackenzie.  "Industry  and  Humanity:  A  Study  in 
the  Principles  Underlying  Industrial  Reconstruction."  Boston, 
Houghton,   Mifflin  Company,   19 18. 

Kline,  George  M.  "Function  of  the  Social  Worker  in  Relation  to 
a  State  Program,"  Proceedings  of  Naiional  Conference  of  So- 
cial Work,  1919;  also  in  Mental  Hygiene,  October,  1919. 

.     "Social  Service  in  the  State  Hospitals,"  American  Journal 

of  Insanity,  v.  72,  PP-  567-581,  April,  1917. 

Kline,  Lila.  "Personal  Psychiatric  History,"  Mental  Hygiene,  v. 
6,  pp.  93-124,  January,  1922. 

KoBER,  George  Martin,  and  Hanson,  William  Clinton.  "Diseases 
of  Occupation  and  Vocational  Hygiene."  Philadelphia,  Blackis- 
ton's  Son  &  Company,  1916. 

Kraepelin,  Emil.  "Psychiatrie :  Ein  Lchrbuch  fiir  Studirende  und 
Aerzte,"  5  Auflage.     Leipzig,  Barth,   1896. 

Kropotkin,  p.  "Mutual  Aid:  A  Factor  in  Evolution,"  revised  edi- 
tion.    London,  Heinemann,  1904. 

Lee,  Joseph.  "Play  in  Education."  New  York,  The  Macmillan  Com- 
pany, 1916. 

MacCurdv,  J.  T.  "Psychiatric  Clinics  in  the  Schools,"  American 
Journal  of  Public  Health,  v.  6,  pp.   1265-1271,   December,   1916. 

.     "War  Neuroses."     Cambridge,  Eng.,  University  Press,  1918. 

Also,  Psychiatric  Bulletin,  v.  2,  pp.  243-354,  July,  1917. 

Macdonald,  J.  B.  "Community  Value  of  the  Out-Patient  Depart- 
ment of  the  Hospital  for  the  Insane,"  Mental  Hygiene,  v.  i,  pp. 
266-73,  April,  1917.  Massachusetts  Society  for  Mental  Hygiene, 
Publication  No.  28. 

McDouGALL,  William.  "An  Introduction  to  Social  Psychology." 
Boston,  Luce,  1918. 

.  "The  Group  Mind :  A  Sketch  of  the  Principles  of  Collec- 
tive Psychology  with  Some  Attempt  to  Apply  Them  to  the  In- 
terpretation of  National  Life  and  Character."  New  York,  G. 
P.  Putnam's  Sons,  1920. 

Magnan,  Valentine.  "De  I'alcoholisme,  des  diverses  formes  du 
delire  alcoholique  et  de  leur  traitement."     Paris,  Delahaye,  1874. 

Marot,  Helen.  "Creative  Impulse  in  Industry :  A  Proposition  for 
Educators."     New  York,   E.   P.   Dutton  &  Company,   1918. 


BIBLIOGRAPHY  6gi 

Mental  Hygiene  (quarterly).  New  York,  National  Committee  for 
Mental  Hygiene,  January,  1917 — date. 

"A  Mental  Hygiene  Primer" :  A  Series  of  Brief  Articles  on  the 
Symptoms  and  Especially  the  Prevention  of  the  More  Common 
Types  of  Mental  Disorders.  Boston,  Massachusetts  Society  for 
Mental  Hygiene,  1922. 

Merz,  John  Theodore.  "A  History  of  European  Thought  in  the 
Nineteenth  Century."  Edinburgh  and  London,  W.  Blackwood 
&  Sons,  1903-1914. 

Meyer,  Adolf.  "The  Right  to  Marry :  What  Can  a  Democratic 
Civilization  Do  about  Heredity  and  Child  Welfare  ?"  Mental  Hy- 
giene, V.  3,  pp.  48-58,  January,  1919.  Originally  printed  in  the 
Survey,  v.  36,  pp.  243-246,  June  3,  1916. 

Munsterberg,  Hugo.  "Psychology  and  Industrial  Efficiency."  Bos- 
ton, Houghton  Mifflin  Company,  1913. 

Myerson,  Abraham.  "The  Foundations  of  Personality."  Boston, 
Little,  Brown  &  Company,  1921. 

.  "The  Nervous  Housewife."  Boston,  Little,  Brown,  &  Com- 
pany, 1920. 

.  "Psychiatric  Family  Studies,"  American  Journal  of  In- 
sanity, V.  y^,  pp.  355-486,  January,  1917. 

.  "Psychiatric  Family  Studies,"  Second  Paper,  American  Jour- 
nal of  Insanity,  v.  74,  pp.  497-554,  April,  1918. 

"The  Psychiatric  Social  Worker."     Massachusetts  Commis- 


-  sion  on  Mental  Diseases.  Bulletin,  v.  3,  No.  2,  pp.  113-217,  April, 
1919. 

Neff,  Irwin  H.  "Inebriety  and  How  to  Control  It,"  Boston  Medical 
and  Surgical  Journal,  v.  176,  pp.  337-341,  March  8,  1917. 

Ordway,  Mabel  D.,  and  Ryther,  Margherita.  "Economic  Effi- 
ciency of  Epileptic  Patients,"  Journal  of  Nervous  and  Mental  Dis- 
eases, V.  47,  No.  5,  May,  1918. 

OsLER,  William.  "Principles  and  Practice  of  Medicine,"  8th  edition. 
New  York,  Appleton,  1918. 

Park,  Robert  E.  and  Burgess,  Ernest  W.  "Introduction  to  the 
Science  of  Sociology."  Chicago,  University  of  Chicago  Press, 
1922. 

Parker,  Carlton  H.  "The  Casual  Laborer  and  Other  Essays." 
New  York,  Harcourt,  Brace  &  Howe,  1920. 

Parker,  Cornelia  Stratton.  "An  American  Idyll :  The  Life  of 
Carleton  H.  Parker."     Boston,  Atlantic  Monthly  Press,  1919. 

Parmalee,  M.  F.  "Science  of  Human  Behavior :  Biological  and 
Physiological  Foundations."  New  York,  The  Macmillan  Com- 
pany, 1913. 

PiNEL,  Ph.  "Nosographie  philosophique  ou  la  methode  de  I'analyse 
applique  a  la  medecine."     Paris,   Brosson,   1818. 


692  BIBLIOGRAPHY 

Pound,  Roscoe.     "Criminal  Justice  in  the  American  City."     Section 

8  of  Report  of  the  Cleveland  Foundation's  Survey  of  Criminal 

Justice.     Cleveland,  1922. 
.     "Individual  Interests  in  the  Domestic  Relations,"  Michigan 

Law  Review,  v.    14,   January,    19 16. 
■ .     "Interests  of  Personality,"  Harvard  Law  Review,  February 

and  March,  1915. 

"The  Future  of  the  Criminal  Law,"  Columbia  Law  Review, 


V.  21,  January,  1921. 

.  "Social  Problems  and  the  Courts,"  American  Journal  of  So- 
ciology, V.  18,  November,  1912. 

.  "A  Theory  of  Social  Interests,"  Proceedings  of  the  Ameri- 
can Sociological  Society,  v.  15,  May,  1921. 

Pov^ERS,  Margaret  J.  "The  Industrial  Cost  of  the  Psychopathic 
Employee,"  Proceedings  of  the  National  Conference  of  Social 
Work,  1920. 

Pusey,  W.  Allen.  "Syphilis  As  a  Modern  Problem."  Chicago, 
American  Medical  Association,   1915. 

Quetelet,  L.  a.  J.  "Physique  sociale,  un  essai  sur  le  developement 
des  facultes  de  I'homme."     Bruxelles,  Muquardt,  1869. 

Ralph,  Georgia  G.  "Elements  of  Record  Keeping  for  Child-Help- 
ing   Organizations."      New    York,    Russell     Sage    Foundation, 

1915- 

Ray,  Isaac.     "Mental  Hygiene."     Boston,  Ticknor  &  Fields,  1863. 

Read,  Thomas  T.  "The  Employment  Manager  and  the  Reduction  of 
Labor  Turnover,"  Proceedings  of  the  American  Institute  of  Min- 
ing Engineers,  February,  1918. 

Redlich,  Josef.  "The  Common  Law  and  the  Case  Method:  A  Report 
to  the  Carnegie  Foundation  for  the  Advancement  of  Teaching." 
New  York,  1914. 

Richmond,  Mary  E.  "Social  Diagnosis."  New  York,  Russell  Sage 
Foundation,   1917. 

.    "What  is  Social  Case  Work :    An  Introductory  Description." 

New  York,  Russell  Sage  Foundation,  1922. 

Robeson,  F.  E.  "A  Progressive  Course  of  Precis  Writing."  London, 
Oxford  University  Press,   1913. 

R«BiNsoN,  James  Harvey.  "The  Mind  in  the  Making:  The  Relation 
of  Intelligence  to  Social  Reform."  New  York,  Harper  &  Broth- 
ers, 1921. 

Robinson,  Virginia  P.  "Analysis  of  Processes  in  the  Records 
of  Family  Case  Working  Agencies,"  Proceedings  of  the  Na- 
tional Conference  of  Social  Work,  1921 ;  also  The  Family,  July, 
1921. 

Rosanoff,  Aaron  J.  "Manual  of  Psychiatry,"  5th  edition.  New 
York,  Wily  &  Sons,  1920. 


BIBLIOGRAPHY  693 

Ross,  E.  A.     "Foundations  of   Sociology."     New  York,  The   Mac- 
millan  Company,  1905. 

.     "Principles  of  Sociology."     New  York,  The  Century  Com- 
pany, 1921. 

"Social  Control :     A  Survey  of  the  Foundations  of  Order." 


New  York,  The  Macmillan  Company,  1904. 

RossY,  C.  S.  "Feeble-mindedness  and  Industrial  Relations,"  Mental 
Hygiene,  January,  191 8. 

RoYCE,  JosiAH.  "Fugitive  Essays."  Cambridge,  Harvard  University 
Press,  1920. 

.  "Studies  of  Good  and  Evil :  A  Series  of  Essays  upon  Prob- 
lems of  Philosophy  and  Life."  New  York,  D.  Appleton  &  Com- 
pany, 191 5.  ^ 

Ryther,  Margherita.  "Place  and  Scope  of  Psychiatric  Social  Work 
in  Mental  Hygiene,"  Mental  Hygiene,  v.  3,  pp.  636-645,  October, 
1919. 

Ryther,  Margherita,  and  Ordway,  Mabel  D.  "Economic  Efficiency 
of  Epileptic  Patients,"  Journal  of  Nervous  and  Mental  Diseases, 
v.  47,  No.  5,  May,  1918. 

Salmon,  Thomas  W.  "Care  and  Treatment  of  Mental  Diseases  and 
War  Neuroses  (Shell-Shock)  in  the  British  Army."  New  York, 
National  Committee  for  Mental  Hygiene,   1917. 

.     "Importance  of  Social  Service  in  Connection  with  the  State 

Hospitals  for  the  Insane,"  New  York  State  Hospital  Quarterly, 
v.  2,  pp.  175-181,  February,  1917. 

"Some  New  Problems   for  Psychiatric   Research  in   Delin- 


quency," Mental  Hygiene,  v.  4,  pp.  29-42,  January,  1920;  also  in 
Journal  of  Criminal  Law  and  Criminology,  v.  10,  pp.  375-384, 
November,  1919. 

Sartorio,  Enrico  C.  "Social  and  Religious  Life  of  Italians  in 
America."     Boston,  Christopher  Publishing  House,  1918. 

Sears,  Amelia.  "The  Charity  Visitor :  A  Handbook  for  Beginners," 
3rd  edition.  Chicago,  School  of  Civics  and  Philanthropy, 
1918. 

Shand,  a.  F.  "The  Foundations  of  Character."  London,  The  Mac- 
millan Company,  1914. 

Sheffield,  Ada  E.  "Report  on  a  Study  of  Applications  for  Illegiti- 
macy Cases."    Boston,  Bureau  on  Illegitimacy,  1920. 

.  "The  Social  Case  History :  Its  Construction  and  Con- 
tents."    New  York,  Russell  Sage  Foundation,  1920. 

Singer,  H.  D.  "Function  of  the  Social  Worker  in  Relation  to  the 
State  Physician,"  Mental  Hygiene,  v.  3,  pp.  609-617,  October, 
1919. 

Small,  Albion  W.  "General  Sociology."  Chicago,  University  of 
Chicago  Press,   1905. 


694  BIBLIOGRAPHY 

Smith,  G.  E.,  and  Pear,  T.  H.  "Shell  Shock  and  its  Lessons." 
New  York,  Longmans,  Green  &  Company,  1917. 

Solomon,  Harry  C.  "Social  Workers  for  Mental  Hygiene,"  Modern 
Medicine,  v.  2,  No.  6,  pp.  465-466. 

.  "What  Shall  Be  the  Attitude  of  the  Public  toward  the  Re- 
covered Insane  Patient,"  Boston  Medical  and  Surgical  Journal, 
V.   174,  No.   16,  April   13,   1916. 

Solomon,  Harry  C.  and  Maida  H.  "The  Effects  of  Syphilis  on  the 
Families  of  Syphilitics  Seen  in  the  Late  Stages,"  Social  Hygiene, 
V.  6,  pp.  469-487,  October,  1920. 

.     "The  Family  of  the  Neurosyphilitic,"  Mental  Hygiene,  v.  2, 

January,  1918. 

"A  Study  of  the  Economic  Status  of  Forty-One  Paretic  Pa- 


tients and  Their  Families,"  Mental  Hygiene,  v.  5,  pp.  556-565, 
July,  1 92 1. 

Solomon,  Harry  C,  and  Southard,  E.  E.  "Neurosyphilis :  Modern 
Systematic  Diagnosis  and  Treatment."  Boston,  W.  M.  Leonard, 
1917. 

Solomon,  Maida  H.  "Social  Work  and  Neurosyphilis,"  Social  Hy- 
giene, V.  6,  pp.  93-104,  January,  1920. 

.  "The  Social  Worker's  Approach  to  the  Family  of  the  Syphi- 
litic," Hospital  Social  Service,  v.  3,  p.  442,  1921. 

Southard,  E.  E.  "Alienists  and  Psychiatrists :  Notes  on  Divisions 
and  Nomenclature  of   Mental   Hygiene,"  Mental  Hygiene,  v.    i, 

pp.  567-571,  1917- 

.  "Cross-sections  of  Mental  Hygiene,  1844,  1869,  1894.  Presi- 
dential Address  at  Annual  Meeting  of  American  Medico-Psy- 
chological Association,  1919,"  American  Journal  of  Insanity,  v. 
y6,  pp.  91-111,  1919. 

.  "Diagnosis  per  E.xclusionem  in  Ordine :  General  and  Psychi- 
atric Remarks."  Bulletin  of  Massachusetts  Commission  on  Men- 
tal Diseases,  v.  2,  No.  3,  pp.  90-122,  1918. 

.    "The  Empathic  Index  in  the  Diagnosis  of  Mental  Diseases," 

Journal  of  Abnormal  Psychology,  v.  13,  pp.  199-214,  1918. 

.     "Feeble-mindedness  as  a  Leading  Social  Problem,"  Boston 

Medical  and  Surgical  Journal,  v.  170,  pp.  781-784,  May  21, 
1914. 

.     "Functions  of  a  Psychopathic  Hospital,"  Canadian  Journal 

of  Mental  Hygiene,  v.  i,  pp.  4-19,  1919. 

.  "Individual  versus  the  Family  as  a  Unit  of  Interest  in  So- 
cial Work,"  Mental  Hygiene,  v.  3,  pp.  436-444,  1919. 

.     "A   Key  to  the  Practical   Grouping  of   Mental   Diseases." 

Bulletin  of  Massachusetts  Commission  on  Mental  Diseases,  v.  2, 
No.  I,  pp.  5-24,  1 9 18. 


BIBLIOGRAPHY  695 

Southard,  E.  E.  "The  Kingdom  of  Evils :  Advantages  of  an  Or- 
derly Approach  in  Social  Case  Analysis,"  Proceedings  of  Na- 
tional Conference  of  Social  Work,  1918. 

.     "Mental  Hygiene  and  Social  Work :     Notes  on  a  Course  in 

Social  Psychiatry  for  Social  Workers,"  Mental  Hygiene,  v.  2, 
pp.  388-406,  July,  1918;  also  in  Massachusetts  Commission  on 
Mental  Diseases,  Bulletin,  v.  3,  No.  2,  pp.  52-70,  April,  1919. 

.  "The  Modern  Specialist  in  Unrest :  A  Place  for  the  Psychi- 
atrist in  Industry,"  Journal  of  Industrial  Hygiene,  v.  2,  pp.  10-19, 
May,  1920;  also  Industrial  Management,  June,  1920.  Reprinted 
by  Engineering  Foundation,  New  York. 

.  "Movement  for  a  Mental  Hygiene  of  Industry,"  Mental  Hy- 
giene, v.  4,  pp.  43-64,  January,  1920 ;  also  Industrial  Manage- 
ment, February,  1920.  Reprinted  by  Engineering  Foundation, 
New  York. 

.     "The   Psychopathic   Hospital   Idea,"   Journal   of  American 

Medical  Association,  v.  61,  pp.  1972-1974,  1913. 

,  "Range  of  the  General  Practitioner  in  Psychiatric  Diag- 
nosis," Journal  of  American  Medical  Association,  v.  73,  pp.  1253- 
1256,  1919. 

.  "Shell-Shock  and  Other  Neuropsychiatric  Problems,  Pre- 
sented in  Five  Hundred  and  Eighty-nine  Case  Histories  from 
the  War  Literature,  1914-1918."  Boston,  W.  M.  Leonard, 
1920. 

,  "Sigmund  Freud,  Pessimist,"  Journal  of  Abnormal  Psy- 
chology, V.  14,  pp.  197-216,  1919. 

"Trade  Unionism  and  Temperament:     Notes  upon  the  Psy- 


chiatric Point  of  View  in  Industry,"  Mental  Hygiene,  v.  4,  pp. 
281-300,  April,  1920;  also  Industrial  Management,  April,  1920. 
Reprinted  by  Engineering  Foundation,  New  York. 

Southard,  E.  E.,  and  Solomon,  H.  C.  "Neurosyphilis:  Modern 
Systematic  Diagnosis  and  Treatrhent."  Boston,  W.  M.  Leonard, 
1917. 

Spaulding,  Edith  R.  "Training  of  the  Psychiatric  Social  Worker," 
Mental  Hygiene,  v.  3,  pp.  420-426,  July,  1919. 

"Statistical  Manual  for  the  Use  of  Institutions  for  the  Insane."  Pre- 
pared by  the  Committee  on  Statistics  of  the  American  Medico- 
Psychological  Association  in  Collaboration  with  the  Bureau  of 
Statistics  of  the  National  Committee  for  Mental  Hygiene,  New 
York,  1918. 

Stearns,  A.  Warren.  "The  Classification  of  Industrial  Appli- 
cants," American  Journal  of  Insanity,  v.  y6,  pp.  409-417,  April, 
1920. 

.    "Classification  of  Naval  Recruits,"  California  State  Journal 

of  Medicine,  v.  17,  p.  no,  April,  19 19. 


696  BIBLIOGRAPHY 

Stearns,  A.  Warren.  "The  History  as  a  Means  of  Detecting  the 
Undesirable  Candidate  for  EnHstment,  with  Special  Reference  to 
Military  Delinquents."  U.  S.  Naval  Medical  Bulletin,  v.  12, 
pp.  413-418,  July,  1918. 

.  "Importance  of  a  History  as  a  Means  of  Detecting  Psycho- 
pathic Recruits,"  Military  Surgeon,  v.  43,  pp.  652-661,  December, 
1918. 

.      "Psychiatric    Examination    of    Recruits,"    Journal    of    the 

American  Medical  Association,  v.  70,  pp.  229-231,  January  26. 
1918. 

.  "Social  Work  and  Industrial  Hygiene,"  Journal  of  Indus- 
trial Hygiene,  v.  2,  pp.  20-21,  May,  1920. 

.     "Suicide  in  Massachusetts,"  Mental  Hygiene,  v.  5,  pp.  752- 

yyy,  October,  1921. 

"Value  of  Out-Patient  Work  among  the  Insane,"  American 


Journal  of  Insanity,  v.  74,  pp.  595-602,  April,  1918;  also  in  Massa- 
•  chusetts  Commission  on  Mental  Diseases.  Bulletin,  v.  3,  No.  i, 
pp.  74-78,  January,   1919. 

Strecker,  E.  a.  "Bureau  for  Social  Research,"  The  Family,  v,  2,  pp. 
lyy-iyg,  December,   1921. 

Taft,  Jessie.  "Mental  Pitfalls  in  Industry  and  How  to  Avoid  Them." 
Medicine  and  Surgery,  v.  i,  pp.  678-685,  September,  1917. 

.     "Problems  of   Social   Case   Work   with   Children,"   Mental 

Hygiene,  v.  4,  pp.  537-549,  July,  1920. 

.  "Qualifications  of  the  Psychiatric  Social  Worker,"  Proceed- 
ings of  the  National  Conference  of  Social  Work,  1919;  also 
Mental  Hygiene,  v.  3,  pp.  427-435,  July,  1919. 

"What   the    Social    Worker    Learns    from   the    Psychiatrist 


about  her  Problem  Children,"  Modern  Medicine,  v.  i,  pp.  240- 

245,  July,  1919- 

Tarde,  Gabriel.  "Social  Laws."  Translated  from  the  French  by 
Howard  C.  Warren,  with  a  preface  by  James  Mark  Baldwin. 
New  York,  The  Macmillan   Company,   1899. 

Taussig,  F.  W.  "Inventors  and  Money-Makers :  Lectures  on  Some 
Relations  between  Economics  and  Psychology."  New  York,  The 
Macmillan  Company,  1915. 

Tead,  Ordway.  "Development  of  the  Guild  Idea,"  Intercollegiate 
Socialist,  April-May,  1918,  pp.  16-19. 

.  "Instincts  in  Industry :  A  Study  of  Working-Class  Psy- 
chology."    Boston,  Houghton,  Mifflin  Company,   1918. 

Terman,  L.  M.  "The  Hygiene  of  the  School  Child."  Boston,  Hough- 
ton, Mifflin  Company,  1914. 

TiMME,  Walter.  "Indications  for  Internal  Gland  Therapy,"  New 
York  Medical  Journal,  February  7,  1920. 


BIBLIOGRAPHY  697 

Todd,  Arthur  J.  "The  Scientific  Spirit  and  Social  Work."  New 
York,  The  Macmillan  Company,  1919. 

"Training  School  of  Psychiatric  Social  Work  at  Smith  College,"  by 
various  authors,  Mental  Hygiene,  v.  2,  pp.  582-594,  October, 
1918. 

Tredgold,  a.  F.  "Mental  Deficiency :  Amentia,"  2nd  edition.  New 
York,  Wood  &  Company,  1914. 

Trotter,  William.  "Instincts  of  the  Herd  in  Peace  and  War." 
New  York,  The  Macmillan  Company,  1917. 

Tufts,  James  H.,  and  Dewey,  John.  "Ethics."  New  York,  Henry 
Holt  &  Company,  1908. 

Valentine,  R.  G.  "Human  Element  in  Production,"  American  Jour- 
nal of  Sociology,  v.  22,  pp.  477-488,  January,  1917. 

Van  Kleeck,  Mary.  "Case  Work  and  Social  Reform,"  Annals  of 
the  American  Academy  of  Political  and  Social  Science,  v.  yy, 
pp.  9-12,  May,  1918. 

Van  Kleeck,  Mary,  and  Taylor,  G.  R.  "The  Professional  Or- 
ganization of  Social  Work,"  Annals  of  American  Academy  of 
Political  and  Social  Science,  May,  1922. 

Veblen,  Thorstein.  "Instinct  of  Workmanship,  and  the  State  of 
the  Industrial  Arts."  New  York,  The  Macmillan  Company, 
1914. 

"The  Visiting  Teacher  in  the  United  States."  A  Survey  by  the  Na- 
tional Association  of  Visiting  Teachers.  New  York,  Public 
Education  Association,  June,  1921. 

Wallas,  Graham.  "The  Great  Society:  A  Psychological  Analysis." 
New  York,  The  Macmillan  Company,  1914. 

.     "Human  Nature   in   Politics."     Boston,   Houghton,   Mifflin 

Company,  19 16. 

Wallerstein,  Helen  C.  "The  Functional  Relations  of  Fifteen  Case 
Working  Agencies  as  Shown  by  a  Study  of  421  Individual  Fam- 
ilies and  The  Report  of  the  Philadelphia  Intake  Committee." 
Philadelphia,  Bureau  for  Social  Research,  Seybert  Institution, 
1919. 

Wells,  F.  L.  "Mental  Adjustments."  New  York,  D.  Appleton  & 
Company,  19 17. 

.    "The  Status  of  Clinical  Psychology,"  Mental  Hygiene,  v.  6, 

pp.  11-22,  January,  1922. 

White,  William  A.  "Foundations  of  Psychiatry."  New  York 
and  Washington,  Nervous  and  Mental  Disease  Publishing  Com- 
pany, 1921. 

.     "Mechanisms   of   Character   Formation :     An   Introduction 

to  Psychoanalysis."     New  York,  The  Macmillan  Company,  1916. 

.    "The  Mental  Hygiene  of  Childhood."    Boston,  Little,  Brown 

&  Company,  1919. 


698  BIBLIOGRAPHY 

White,  William  A.  "Outlines  of  Psychiatry,"  7th  edition.  Wash- 
ington, Nervous  and  Mental  Disease  Publishing  Company,   1919. 

White,  William  A.,  and  Jelliffe,  S.  E.  "Diseases  of  the  Nervous 
System :  A  Text-book  of  Neurology  and  Psychiatry,"  2nd  edition. 
Philadelphia,  Lea  and  Febiger.  1917. 

Williams,  Frankwood  E.  "Legislation  for  the  Insane  in  Massa- 
chusetts with  Particular  Reference  to  the  Voluntary  and  Tem- 
porary Care  Laws,"  Boston  Medical  and  Surgical  Journal,  v.  173, 
pp.  y22,-y2,A^  November  11,  191 5. 

.    "Mental  Hygiene  and  the  College  Student,"  Mental  Hygiene, 

V.  5,  pp.  283-301,  April,  1921. 

.     "The  State  Hospital  in  Relation  to  Public  Health,"  Mental 

Hygiene,  v.  4,  pp.  885-896,  October,  1920. 

"Treatment  of  Mental  Patients  in  the  General  Hospitals  of 


the  United  States  Army,"  Proceedings  of  the  American  Medico- 
Psychological   Association,   pp.    271-286,   June,    1919. 

Williams,  Frankwood  E.,  and  Brown,  M.  W.  "Neuropsychiatry 
and  the  War :  A  Bibliography  with  xA.bstracts."  New  York,  Na- 
tional Committee  for  Mental  Llygiene,  1918. 

Wolf,  Robert  B.  "Individuality :  The  Key  to  Conscious  Life  Pur- 
pose," Survey,  v.  41,  pp.  620-625,  February  i,  1919. 

.      "Making    Men    Like    Their    Jobs,"     System,    v.    35,    pp. 

34-38,  222-226,  January  and  February,  1919. 

WoRCH,  Margaret.  "Psychiatric  Social  Work  in  a  Red  Cross  Chap- 
ter," Mental  Hygiene,  v.  6,  No.  2,  April,  1922. 

Yerkes,  Robert  M.  "Plow  May  We  Discover  Children  Who  Need 
Special  Care?"  Mental  Hygiene,  v.  i,  pp.  252-259,  April,  1917. 

Yerkes,  Robert  M.,  and  others.  "A  Point  Scale  for  Measuring  Men- 
tal Ability."    Baltimore,  Warwick  and  York,  Incorporated,  191 5. 


INDEX 


Aboulia,    iii    (case    17),   419 

Accident,  fear  of,  328   (case  87) 

Acquired,    217 

Adaptation,    369 

Adjustment,     of     inner     to     outer 

relations,  368 
Adler,    Herman   M.,   347,   487,   499, 

527,  545 
Agoraphobia,    142    (case  24) 
Aid,  charitable,  231 
— financial,   156,    157,   174,  507 
— in   clothing,   337 
—temporary,   108,   196 
Alcohol,  237,  253,  446 
— and  epilepsy,  470 
Alcoholic,    24    (case   4)  ;    35    (case 

6)  ;    113    (case    18)  ;   211    (case 

42)  ;  262    (case  62)  ;  291    (case 

71);  450 
Alcoholic    deterioration,    263    (case 

62) 
Alcoholic  hallucinations,   250    (case 

59). 
Alcoholic    hallucinosis,    253     (case 
60);  257   (case  61);  296   (case 

73)  ;  471 

Alcoholic  jealousy-psychosis,   471 
Alcoholic     psychosis,     245,      (case 

58) ;  262   (case  62)  ;  470 
Alcoholism,     109     (case     17)  ;     133 

(case  23) ;  217   (case  45)  ;  245 

(case  58)  ;  267   (case  63)  ;  348 

(case  94)  ;  446 
Alienist,    438,    439;     (chart)      441; 

443 
Almshouse,  221 
Ambition,   126,  156 
American   Association   of    Hospital 

Social    Workers,    555 
American    Psychiatric    Association, 

437 
Antisyphilitic   treatment,    no    (case 

17)  ;    204    (case   39)  ;   457 
— during  pregnancy,    172    (case  31) 
Anxiety   neuroses,  483 
Apperception,  9 


x\rmy,   215,   233,   240,   242,   308,   361 
Arrested,   17,  294,  356 
Arteriosclerosis,  270   (case  64) 
Associates,   541,   542 
Attitude,  "Borrow  no  trouble,"  285, 

351 
Authority,   547 
— inadequate,  419 
— public,  31 
Autobiography,  73 

Bacon,  Francis,  384,  420 

Bacon,  Roger,  419 

Bad    habits.      See    Vitia,    definition 

of,  412 
Bakunin,  435 
Barker,   Lewellys,   F.,  552 
Baths,    2.      See    also,    Hydrother- 

apeutic  treatment 
Beauty,  404 
Bellevue  Hospital,  520 
Birth  control,  357 
Bismarck,   433 
Blood  tests,  459 
Bodily  disease,  472 
Bolshevism,    430,   435 
Bosanquet,    Mrs.,   539 
Boston  State  Hospital,  520 
Brain  disease,  472 
Brodie,  Sir  Benjamin,  412 
Burleigh,   Edith  N.,  520 

Cabot,    Richard    C,    37^,   423.    5I9, 

522 
Cannon,  Ida  M.,  382,  521 
Capitalist,  435 
Case,    "closed,"    74,    85,    109,    164, 

191,   214,   254,   300 
— "intensive,"  526,  534 
— "slight  service,"  526,  534 
Character,  397 
Character-building,    376,    377 
Character-training,   544 
Charitable   institutions,  attitude  of, 

213 
Chorea,  273  (case  65) 


699 


yoo 


INDEX 


Clausewitz,  433 

Clinic,    dental,   20 

— out-patient,  42 

Clinic  manager,  530 

Cocainism,  472 

Commitment,    106    (case   15) 

— for   observation,    146,    151 

Committable,    149    (case    26)  ;    279 

(case  68)  ;  303    (case  75) 
Community,  367 
— health  of,  459 
Compensation,   108,  116,  340 
Concussion,  231    (case  49) 
Conflict,   12    (case  2) 
Congenital,     217     (case    45)  ;     223 

(case  48)  ;  228  (case  48) 
Consociates,   541 
Constitutional    inferiority,    8    (case 

2)      . 

Constitutional  psychopathic  in- 
feriority, 24  (case  4) ;  359 
(case  98)  ;  487,  490 

Constitutional  psychopathic  in- 
feriors, 497 

Control,  of  desires,  53 

Convulsions,  104  (case  15)  ;  237 
(case  45) 

Cooperation,  90 

Court,  194,  274,  294 

— contempt  of,   194 

Crime,  51,  395,  449 

— disease  or  vice,  178  (case  33) 

Criminal  law,  395 

Criminological    system,   249 

Criminology,  51 

Croix  dc  Guerre,  307 

Crowd,  inexperienced,  419 

Custom,  force  of,  419 

Cyclothymia,  143  (case  25)  ;  295 
(case  73)  ;  313  (case  81)  ;  477 

Cyclothymic,   338   (case  89) 

Cyclothymic  constitution,  21,  (case 
3);  182  (case  25);  235  (case 
52) ;  318  (case  82)  ;  362  (case 
100) 

Cyclothymic  tendency,  69  (case  10) 

Danvers  State  Hospital,  520 

Darwin,  403 

Davis,   Michael   M.,   521 

Defective  delinquent,  487 

Defense  reactions,  22  (case  3)  ;  30 

(case  5) 
Delinquency,  8   (case  2)  ;  ^2   (case 

S)  ;    52    (case    8) ;    245    (case 

S8);  489 


Delinquency     vs.     psychopathy,     14 

(case  2) 

Delinquent,  66    (case  9) 

Dfelirium  tremens,  27  (case  6)  ; 
250  (case  59)  ;  252  (case  60)  ; 
471 

Delusions,  254  (case  60) 

Dementia,  88  (case  12)  ;  271  (case 
64)  ;  298  (case  73) 

— psychological,   473 

Dementia  praecox,  7  (case  i);  10 
(case  2)  ;  13  (case  2)  ;  24 
(case  4)  ;  88  (case  12)  ;  108 
(case  16) ;  115  (case  18)  ;  148 
(case  26) ;  168  (case  31) ;  182 
(case  35)  ;  215  (case  43)  ;  216 
(case  44) ;  224  (case  48) ;  293 
(case  71)  ;  295  (case  j:^)  ;  300 
(case  74)  ;  308  (cases  77,  78)  ; 
310  (case  79)  ;  311  (case  80)  ; 
312  (case  81);  447,  450,  473, 
496 

— catatonic,    286    (case    70) 

— in  feeble-minded  person,  448 

— sexuality  in,  286,    (case  70) 

Dementia  simplex,  284  (case  70) 

Dental  treatment,  549 

Dental  work,  196  (case  38)  ;  231 
(case  49) 

Deportation,  5,  29,  89 

Desertion,  174  (case  32) 

Deteriorate,  477 

Deterioration,  236  (case  53)  ;  298 
(case  7s)  ;  473 

Dewey,  John,  512 

Diagnosis,  change  of,  301  (case  75) 

— importance  to  therapy,  364  (case 
100) 

Diagnostic  decision,  118 

Diary,   319 

Differential   diagnosis,    145 

Dipsomania,  253   (case  60)  ;  501 

Disappeared,  354 

Disease,  definition  of.  See  Morbi, 
definition  of,  411 

— functional,  410 

Draft,   241 

Dragon-slayers,  427 

Dramatis  personae,  540 

Drug,  446,  450 

Dual  personality,  310  (case  80) 

Dubois,  538 

Eccentric,  374,  2,77,  475 
Eccentricities,   380,   401 
Economic  point  of  view,  381,  518 


INDEX 


701 


Economic  unrest,  498 
Economics,  369,  384 
Education,   188,  407 
Educators,   465 
Efificiency,  370,  zn 
Emerson,  406 

Empathic  index,  17 ;  121   (case  20)  ; 
256   (case  60)  ;  269  (case  63)  ; 

477 
Employment    managers,    clinic    for, 

362 
Employment  obtained,  231 
Engineering  Foundation,  499,  531 
Environment,   369 
Epilepsies,  237    (case  53)  ;  450,  469 
Epilepsy,    13    (case   2)  ;    158    (case 

29)  ;  ^2)7   (case  53)  ;  238   (case 

54)  ;  240   (case  55)  ;  242    (case 
_  57)  ;  446,  469 
Epileptic  fugue,  10  (case  2) 
Epileptic   temperament,   469 
Epileptics,  many  eminent  men,   160 

(case  29) 
Epileptiform  equivalent,  470 
Erotic,  315   (case  81) 
Error,   causes   of,  419 
Errores,  definition  of,  411 
Ethics,  364 

Eugenic  researches,  228 
Eugenists,  465 
Evil,  definition  of,  408 

Fabrications,  189,  348,  359 
Family,  229,  234,  367,  466,  535,  562 
— unit  of  interest,  223 
Family  adjustment,  266  (case  62)  ; 

328  (case  87) 
Family  agency,  151 
Family  case,  23  (case  4)  ;  83  (case 

II) 
Family  conference,   102 
Family    problem,    115     (case     19)  ; 

137    (case  24)  ;   171,  506,  508 
Farmer,  Gertrude  L.,  534 
Feeble-minded,    66    (case    9)  ;    103 

(case  15) ;   125    (case  20)  ;   148 

(case  26)  ;  223    (case  48)  ;  227 

(case     48)  ;     229     (case     49)  ; 

233   (case  si);  335   (case  88); 

342   (case  92)  ;  449,  487 
Feeble-mindedness,    84    (case    11)  ; 

96    (case    13)  ;    97    (case    13)  ; 

182  (case  35);  263  (case  62); 

267  (case  63) ;  284  (case  70)  ; 

446;    463;    465;     (chart)     461; 

463-  519 


Fenton   and   Schwab,  492 
Fernald,  Walter  E.,   125,  126,  551 
"Fit   to  work,"  83    (case    11);    117 

(case   19) 
Folie  a  deux,  486 
Follow-up,  278,  530 
Forme    fruste,     14     (case    2)  ;     21 

(case  3)  ;  71    (case  10) 
Foster,  Josephine  Curtis,  183 
Fracture,  of   skull,  233    (case  51)  ; 

238   (case  54) 
Freudian     mechanisms,     336     (case 

88);   688 
Functional,  447 

General    paresis,    203     (case    39)  ; 

215    (case  43)  ;  216   (case  44)  ; 

456 
— 'Costly    delay    of    diagnosis,    203 

(case  39) 
— "fatal  prognosis,"  211  (case  42) 
Glueck,    Bernard,   518,  556 
Gonorrhea     156      (case     28)  ;     358 

(case  96) 
Grail-hunters,   427 
Great  War,  370,  431,  444,  492,  521 
"Great-man"  theory,  498 
Group,   367,   386 
Guardian,   285 

Haeckel,  Ernst,  403 

Hallucinations,  88  (case  12)  ;  263 
(case  62)  ;  305    (case  75) 

— hypnagogic,   115    (case  18) 

Health,  of  wife  and  children,  266, 
268  (case  62) 

Healy,  William,  380,  538,  540 

Henderson,   L.  J.,  369 

Hereditary,  217  (case  45)  ;  223 
(case  48)  ;   228    (case  48) 

Hereditary  taint,  6   (case  i) 

Heredity,  36,  39  (case  6)  ;  iii 
(case  17) ;  155  (case  28)  ;  168 
(case  31)  ;  190  (case  36)  ;  217 
(case  45) ;  228  (case  48)  ;  231 
(case  49) ;  240  (case  54) 

History,   434 

— economic    interpretation    of,   401, 

^34  .       . 

- — psychopathic     interpretation     of, 

401 
Hoboes,  293 
Hohenzollerns,  433 
Homeless  men,  agency  for,  177 
Homosexual,  12  (case  2)  ;  51  (case 

8) 


702 


INDEX 


Hormones,   378 
Hospital  wards,  513 
Housekeeping,  advice  about,  264 
Hume,  David,  404 
Hydrotherapeutic      treatment,     230 

(case  49);  342   (case  91);  549 
Hygiene,  379  _ 
— instruction  in,  176 
Hyperkinetic,    224    (case    48)  ;    226 

(case  48) 
Hypersexuality,    25     (case    4)  ;    58 

(case  8)  ;  355  (case  96)  ;  489 
Hyperthyroidism,    T^,     (case     10)  ; 

2"]^   (case  66) 
Hypnotism,   516 
Hypoboulia,     109     (case     17)  ;     144 

(case  25)  ;  419 
Hypobulic,  353    (case  95)  ;  489 
Hypochondria,    118    (case   19) 
Hypophrenia,   464 
Hypophrenic,   18   (case  3) 
Hysteria,  72   (case   lo)  ;    106    (case 

is)  ;   143    (case  25)  ;  225    (case 

48) ;  242    (case  57) ;  335    (case 

88)  ;  483 
— "mechanisms"   of,    118    (case   19) 
Hysterical,  93    (case   13) 
Hysterical  paralysis,  226   (case  48) 


Idiot,  463 

Ignorance.  Sec  Errores,  definition 
of,  411 

Illegitimate,  96   (case   13) 

Illegitimate  child,  17  (case  3)  ;  98 
(case  14) ;  192  (case  36)  ;  216 
(case  44) :  225  (case  48)  ;  273 
(case  65)  ;  276  (case  66) 

Illegitimate  children,  87  (case  12)  ; 
189    (case  36) 

Imbecile,  463 

Immigrant,  352 

Immigration,  5 

Indigestion,  195   (case  38) 

Individual,    351,    367,    386,    387,    535 

Individualization,  328,  y]7^  380,  421, 
544 

Industrial  accident,  83,  240,  339 

Industrial  Accident  Board,  83,   117, 

339;  503 
Industrial    cases,    family    interests 

in,  506,  510 
Industrial    traumatic    neurosis,    115 

(case  19) 
Inebriety,    chronic,    258    (case    61). 

See  also  Alcoholism 


Infantilism,  24  (case  4)  ;  347   (case 

94) 

Influenza  psychosis,  277    (case  67) 

Inoculation,  241  (case  56)  ;  242 
(case  57) 

Insanity,  371,  438,  519 

—a  legal  concept,  284  (case  70)  - 

—a  legal,  not  medical  unit,  203 
(case  39) 

Institutional  home,  voluntary  re- 
sort to,  125 

Interference,  248 

Intolerance  for  alcohol,  post  trau- 
matic, 36  (case  6) 

Investigation,  213,  543 

Involutional  psychosis,  284  (case  69) 

Irregular  employment,  500 

James.  William,  371,  374,  401,  521, 

557 
Jealousy  psychosis,  255    (case  60)  ; 

262    (case  62) 
Jev^rs,   142,  328 
Job,  mottoes  from,  429 
Jobs,    lost,   267 
Judge,    195,   464 
Jurists,  444 

— cases  of  interest  to,  414 
Juvenile  tabes,  216  (case  45) 

Kellogg,  Theodore  H.,  519 
Kleptomania,     17     (case     3)  ;     144 

(case  25) 
Kober    and    Hanson,    154 
Kraepelin,  474,  487 

Language  difficulty,  106  (case  ^5)  ; 

159    (case  29)  ;   357    (case  97) 
Law,   414 

Law's  delay,  87,  565 
Lawsuits,  294 
Lawyer,  464 
Lead    poisoning,     178     (case    34)  ;i 

231    (case  49) 
Legal  entanglement,  evil  of,  5^5 
Legislators,  465,  513 
Lenin,  435 
Letters      (quoted),     53-56,     67-68, 

125,  176 
Litigation  psychosis,  486 
Litigia,  definition  of,  414 
Lucas,   W.   P.,  521 
"Lump    sum"    settlement,    85,    119, 

340 

McMahon,  Katherine,  521 
Maladjustments,  369  < 


INDEX 


703 


Malecidal,  427 

Maleducated,  411 

Malthus,  402 

Malthusian,  357 

"Man  crazy,"  79,  (case  10) 

Manhattan  State  Hospital,  520 

Manic  depressive  psychosis,  13 
(case  2) ;  21  (case  3)  ;  24 
(case  4) ;  31  (case  6)  ;  142 
(case  25)  ;  216  (case  44)  ;  295 
(case  72)  ;  312  (case  81)  ;  317 
(case  82)  ;  447,  450,  477,  501 

Mannerisms,  302    (case  75) 

Man's  attire,   133 

"Marginal"  status,  14   (case  2) 

Marital  discord,  162  (case  30)  ; 
194   (case  2,7) 

Marx,  435,  498 

Massachusetts  General  Hospital, 
520,  522 

Massachusetts  School  for  the 
Feeble-minded,  551 

Masturbation,  108  (case  16)  ;  302 
(case  75) ;  352  (case  95)  ;  355 
(case  96) 

Maternity  home,  274 

Medical  care,  214 

Medical    diagnosis,    142,    144,    168, 

313 

Medical  schools,  437,  556 

Medical  social  work,  381,  423,   555 

Medical  social  worker,  223,  350,  559 

Medical   sociology,  556,  558 

Medical  treatment,   549 

Medicine,  384,   553 

Melancholia,     143     (case    25)  ;    182 

(case  34) 
Menance,   89 

Meniere's  disease,  352    (case  95) 
Men's   Club,   35,   38,   246,  256,   292, 

318,  332,  450,  531 
Mental  disease,  284  (case  70)  ;  296 

(case  72)  ;  371,  437,  438 
— alcoholic,  253  (case  60) 
— faked,  308  (case  78) 
— orderly  diagnosis  of,  445 
— popular  prejudice,  270 
Mental  hygiene,   161,  221,  272,  382, 

438,  552 
— aim  of,  374 
— of  industry,  86,  498 
— national  committee  for,  372,  521 
Mental  hygiene  aide,  559 
Mental  hygiene  movement,  521 
Mental  hygiene  program,  552 
Mental  rating,  86  (case  11) 


Mental  sciences,  368 

Mental  tests,   182,  219,  449 

— conditions  favorable  for,  219 

— impulsive  answers,  299  (case  74) 

—irregularity  in,  155,  178,  262, 
(case  62) ;  276  (case  66) 

— limitations  of,  220.  See  also 
Psychological  tests ;  Psycho- 
metric tests 

Milk  and  Baby  Hygiene  Associa- 
tion,   121 

Money  raised,  152 

IMonomania,    486 

]\Iontesquieu,  404 

Montessori,   Madam,    504,    551 

Moral,  22  (case  4)  ;  249  (case  58)  ; 
357  (case  97) 

— definition  of,  14  (case  2) 

Moral  defect,  390 

"Moral   insanity,"  60    (case  8) 

Moral   problems,   407 

Moral   training,  399 

Moral  trouble,  395 

Morals,   512 

Morbi,  definition  of,  411 

Moron,  172,  (case  32)  ;  219  (case 
47)  ;  232  (case  50)  ;  262  (case 
62)  ;  463,  503 

Morphinism,  267  (case  63)  ;  471, 
472 

Multiplication  of  evils,  542 

Multiplication  vs.   summation,  422 

Murder,  238 

— story  of  seeing,  268 


National  Conference  of  Social 
Work,  519,  522,  554,  555 

National  Research  Council,  399 

Navy,  232,  359 

Neglected   child,    167    (case  31) 

Nephritis,  359   (case  98) 

Nervous  breakdown,  5  (case  i)  ; 
484 

Neurasthenia,  5  (case  i)  ;  143 
(case  25)  :_203  (case  39)  ;  483 

Neurologist,  clinical,  444 

Neurones,  378 

Neuropsychiatrist,  444,  552 

Neurosyphilis,  203  (case  39);  455; 
chart,  pp.  453-455 

— diffuse.  See  Syphilis,  cere- 
brospinal 

— prognosis  of,  458 

New  York  School  of  Social  Work, 
556,   560 


704 


INDEX 


New     York     State     Charities     Aid 

Association,  520,  526 
Nietzsche,  425,  433 
Non-support,    192    (case  27) 
Nurse,  557 

Observation,  544 

— objective,  545 

Occupation  neurosis,  154  (case  27) 

Occupational  orbit,  38 

Occupational  therapy,  119,  149,  551 

Occupations,   classihcation  of,  84 

Old  age,   472,   473 

— psychoses  of,  270  (case  64) 

"On  visit,"   322    (case  84) 

Order,  431 

— social  case  analysis,  394,  402. 
See  also  Mental  disease,  order- 
ly diagnosis  of 

Organic,  42  (case  7)  ;  447 

Orthopedic,  36    (case  6)   442 

Out-patient,  234;  317  (case  82); 
328    (case  87);    352    (case  95) 

Out-patient   department,    161,  513 

Out-patient  service,   512 

"Overt  act,"  52  (case  8)  ;  150  (case 
26) ;  316   (case  81) 

Paranoia,  247    (case  58) ;  486 

Paranoid,  488 

"Paranoid  condition,"  307  (case 
76) 

Paraphrenia,  247  (case  58)  ;  294 
(case  72)  ;  475 

Parker,  Carleton,  401 

Pass  system,  97 

Pathological  intoxication,  253  (case 
60) 

Pathological   lying,  490 

Patient's   story,  quoted,   323-325 

Pennsylvania  School  for  Social 
Service,  556,  560 

Penuriae,  definition  of,  415 

"Perioganic,"  43  (case  7)  ;  114 
(case  18) 

Permanent  Charity  Fund,  In- 
corporated,  499 

Personality   of   worker,  60 

Philanthropist,   277 

Philanthropy,  390 

Philosophical   idealism,   424 

Physique,  349   (case  94) 

Placed-out,    129 

Placing-out,  96,  275 

Police,   10 

Political  science,  369,  384 


Politics,  psychiatric  analysis  of,  435 
Pound,  Roscoe,  2>^,  385,  563 
Poverty,  398 
Practice    work,    with    social    cases, 

S6i  . 
Pragmatic,  413 
Prenatal    care,    96    (case    12)  ;    164 

(case  30) 
Preventive  medicine,  373,  552 
Prison  psychosis,  486 
Privacy,    no   (case   17) 
"Private,"  385,   386 
Probation,   53    (case  8)  ;   66    (case 

9)  _;   321    (case  84) 
Probation  system,  79 
Professional   attitude,    547  ' 
Prognosis,  153  (case  27)  ;  306  (case 

75) 
— persistent     social     problem,     275 

(case  65) 
Prohibition,   248,  269 
Promiscuity,  57  (case  8)  ;  70  (case 

10)  ;   156   (case  28)  ;  353   (case 
96) 

Prostitute,  53    (case  8)  ;    158   (case 

28) ;  342   (case  92) ;  353   (case 

96) 
Prostitution,   449 

Pseudo-hallucinations,  88  (case  12) 
Psychasthenia,  339    (case  89) 
Psychasthenic,    114    (case    18)  ;    143 

(case  25) ;   145   (case  25)  ;  204 

(case  39)  ;  339  (case  89)  ;  483 
Psychiatric    examination,    475 
— negative  values  of,  222 
Psychiatric   point   of    view,   60,    79, 

96,  375.  376,  466,  544 
Psychiatric  social  cases,  375 
Psychiatric  social  work,  23,  87,  90, 

96,   195,  378,  379,  381,  518,  S19. 

521,  522,  543,  555 
— chronology  of,  520 
Psychiatric,    social    worker,    39,   61, 

116,  216,  223,  313,  350,  382,  503, 

5 IS,   552,   556,  559 
"Psychiatric  touch,"  235    (case  52) 
Psychiatrist,  61,  222,  443,  chart,  p. 

441 
Psychiatry,  350,  371,  383,  437,  438, 

443 
— broad  conception  of,  446 
— textbooks  on,  445 
Psychoanalysis,   516 
Psychoanalyst,   12,  353 
Psychoanalytic,     336      (case     88)  ; 

338   (case  89) 


INDEX 


705 


Psychogenic,  88  (case  12)  ;  117 
(case  19)  ;   181    (case  34) 

Psychological  examination,   146 

— by   non-English   norms,    147 

Psychological   examiner,   553 

Psychological  level,  147 

Psychological  tests,  84,  iii.  See 
also  Mental  tests;  Psycho- 
metric tests 

Psychologist,  222 

— a  scientific  person,  553 

— limitations    re    medical    practice, 

331 

Psychology,   369 

Psychometric    rating,    118 

Psychometric  tests,  9,  65,  178,  220, 
234,  285.  See  also  Mental 
tests ;   Psychological  tests 

Psychoneuroses,  89  (case  12)  ;  143 
(case  25)  ;  204   (case  39)  ;  483 

Psychoneurosis,  108  (case  16)  ;  141 
(case  24)  ;  153  (case  27)  ;  180 
(case  34) ;  193  (case  37)  ;  301 
(case  75);  312  (case  81);  328 
(case  87)  ;  450 

Psychoneurotic,  128  (case  21)  ;  137 
(case  24)  ;  195  (case  z?)  ',  227 
(case  48) 

Psychopathia  sexualis,  22  and  25 
(case  4)  ;  133  and  136  (case 
^2)  ;.353   (case  96)  ;  486,  490 

— congenital,    137    (case   23) 

Psychopathic,  6  (case  i)  ;  375 

Psychopathic    employee,    339    (case 

89) ;  531 

Psychopathic  Hospital,  247 
Psychopathic   Hospital   social  serv- 
ice, 520,  523,  524 
Psychopathic    husband,     162     (case 

30) 

Psychopathic    personality,    8    (case 

2) ;  20  (case  3)  ;  24  (case  4)  ; 

29   (case  5)  ;  30   (case  5)  ;   69 

(case  10)  ;   122    (case  20)  ;   134 

;   154   (case  28)  ; 

;   189  (case  36)  ; 

235    (case  52)  ; 

273   (case  65)  ; 

347    (case  94)  ; 

362  (case  100)  ; 


(case  23) 

(case  33) 

(case  48) 

(case  63) 

(case  74) 

(case  96) 

472,  486,  489 
Psychopathologist,   443 
Psychopathology,  371,  443 
Psychopaths,    situations    dominated 

by,  S40 
Psychosis,  acute,   159   (case  29) 


177 
224 
267 
299 

354 
420, 


Psychosis    of    the    deaf,    99    (case 

14) 
Psychotherapeutic  methods,    143 
Psychotherapy,  38,  60,  141,  180,  313, 

328,    338,    364;    chart,    pp.    481, 

484,  514,  515 
Public,  385,  386,  387 
Public  agency,  229 
Public  care,  97,  106 
Public    charge,    53    (case   8)  ;    234 

(case  52) 
Public  education,  532 
Public  health,  272,  552,  558 
Public  health  movement,  383 
Public  health  nurse,  558 
Punishment,  546 
Putnam,    James   Jackson,   378,   520, 

538 
Pyorrhea,  263    (case  62) 
Pyromania,  65    (case  9) 


Quetelet,  376 


Ralph,  Georgia  C,  534 
Rationalization,    35,    38    (case    6)  ; 

145   (case  25)  ;  338   (case  89)  ; 

364  (case  loo) 
Ray,  Isaac,  554 
Recidivism,  64 
Recidivist,  233  (case  51) 
Reconstruction,  370,  430 
Red  Cross,  493,  522 
Reeducation,  413 
Reformation,  413 
Relation   of   patient   to   himself,  44 

(case  7) 
Relief,  518  _ 
Religious  views,  425 
Research,  531,   536 
Resourcelessness.    See  Penuriae. 

definition  of,  415 
Responsibility,  26,  245,  412,  544 
Results,  summary  of,  138-41    (case 

24) ;    169-71    (case  31) 
Richmond,   Mary  E.,  375,  392,  422, 

538,   540 
Ross,  E.  A.,  405,  498 
Rousseau,  402 
Royce,   Josiah,  423,   521 
Ryther,  Margherita,  522 


Sailor,  323,  341 

St.   Vincent   de   Paul,   517 


7o6 


INDEX 


Schizophrenia,    lo    (case    2)  ;     108 

(case  16) ;  293    (case  71)  ;  301 

(case  75);  313   (case  81);  361, 

(case  100)  ;  473 

Schizophrenics,    colonies    for,    287 

(case  70) 
School,  322 

School  for  feeble-minded,  230,  551 
— waiting  list,   221,   224 
Schopenhauer,  433 
Schwab  and  Fenton,  492 
Seclusive,   108 
Seguin,  504,  551 
Self-reliance,  advantage  of  counsel 

vs.  possibility  of  loss  of,  341 
Senile,  472 

Senile  dementia,  271    (case  64) 
Senile  psychosis,  279    (case  68) 
Sense   deprivation   psychosis,   486 
Sex  experience,  infantile,    17    (case 

3)  ;  336  (case  88) 
Sex     obsessions,     338     (case    89)  ; 

342    (case  91) 
Sexual  impotence,  262   (case  62) 
Sheffield,  Mrs.  Ada  E.,  534 
Shell-shock,     117     (case     19);     311 

(case  80)  ;  492 
Shell-shock  analogue,   42    (case   7) 
Small,  A.  W.,  404 
Smith,    Adam,   404 
Smith  College,  521,  556 
Smith  College  Training  School  for 

Social  Work,  560 
Sociability,  406 
Social,   387 

Social  adjustment,  486 
— specialist   in,   370 
Social    agencies,    86,    93,    i73.    229, 

234.  356 
— family  known  to,  24,  234 
— variety   of,   72 
Social  care,  215 
Social  case  work,  381,  562 
Social  clinics,  533 
Social    diagnosis,    245     (case    58)  ; 

376,   538 
Social   examination,   525,  543 
Social  history.   146,  239,  447,  525 
Social  incurability,  74  (case  10) 
Social  justice,  277 
Social  medicine,  558 
Social  prognosis,  53 
Social  psychiatry,   193,  523,  562 
Social  records,  189,  389,  534,  536 
Social  Science  Association,  554 
Social  service,  301 


Social  service,  contributary  to  diag- 
nosis, 294 

— failure,   269 

— function  of,   524,   530 

— organization  of,   527 

Social  summary,   122,   174-176 

Social   supervision,   527 

Social  symptoms,  -141,  193,  258 
(case  61)  ;  356,  528 

Social  treatment,  52,  164,  212,  228, 
259,  304,  313,  318,  437,  525, 
537.  538,  543 

— record  of,  99-102  (case  14)  ;  112- 
113    (case   17) 

Social  work,  379,  380,  438,  515,  524, 

543.  553 
—an  art,  554 
— empty  formulae  in,  421 
— relation  to  medical  work,  525 
— theory  of,  367 
Social  worker,  31,  40,  102,  176,  222, 

.  330,  350,  370,  450,  464,  559 
— limitations    re    medical    practice, 

331 
— not  religious?,  429 
— practical,  425,  427 
— splint  to  the  will,  43  (case  7) 
— task  of,  239 

Social  workers,  psychiatric  instruc- 
tion for,  350 
— case  familiar  to,  350 
Socialism,  435 
Socialization,  problem  of,  108  (case 

16) 
Society,  menace  to,  52 
Society    for    After-Care   of    Insane 

in  England,  520 
Sociologist,  559 
Sociology,  367,  369,  556,  558 
Soldier,  215,  241,  306,  308,  310,  326, 

342,  344 
Solomon,   Harry   C,    154,   203,   205, 

207,   216,   449,  455,    502 
Solomon,  Maida  H.,  502 
Special  class,  230 
Spencer,   Herbert,  368,  498 
Spheres  of  influence,  2>7^,  385 
"Splitting"  of  personality,  473 
Spoiled  child,  299   (case  74) 
State    care,    372.     See   also    Public 

care 
State  hospital,  122,  271,  299 
State  hospital  vs.  private  boarding 

place,  271 
Stearns,  A.  Warren,  531 
Street-walker,  355  (case  q6) 


INDEX 


707 


Struggle  for  existence,  403 

Stuckenburg,  405 

Students,  training  of,  531 

Sublimation,    108 

Subnormal,  18  (case  3)  ;  234  (case 

52)  ;  374,  463 
Suicidal     attempt,     99 ;     168     (case 

31) ;  291    (case  71)  ;  299   (case 

74) ;  348   (case  94) 
Suicidal  intent,  134 
Suicide,  potentiality  of,  479 
— feigned,  154 
Summands,  542 
Summary,  537 

Summary   of    results,   264-266 
Summation  of  evils,  542 
Summation  vs.   multiplication,  422 
Supervision,     medical     and     social, 

293 

"Symptom"  catalogue,  258 

Symptoms,  85,  451 

Syphilis,  51  (case  8)  ;  72  (case 
10) ;  99  (case  14)  ;  104  (case 
15)  ;  109  (case  17)  ;  172  (case 
31)  ;  203  (case  39)  ;  217  (case 
45 ;  218  (case  46)  ;  226  (case 
48) ;  355  (case  96) ;  446, 
530 

— blood  test  for,   family,  217   (case 

45) 
— cerebrospinal,     205      (case     40)  ; 

211   (case  42)  ;  504 
— congenital,    103     (case    15)  ;    168 

(case  31) ;  216  (case  45) 
— familial,  207  (case  41) 
• — routine    examination    of     family, 

207   (case  41) 
— sustained   treatment   difficult,   212 

(case  42) 
— tests,  204  (case  39) 
Syphilitic,  225  (case  48) 
Syphilitic  child,  51    (case  8) 
Syphilitic  parents,  348   (case  94) 
Syphilitic  taint,  227   (case  48) 

Taboparesis,  215    (case  44) 

Taft,  Jessie,  556 

Tarde,  498 

Taussig,  380 

Technique,    40,    96,    392,    401,    543, 

562  _ 
— of  social  virork,  61 
Temperament,  511 
Temperamental,    41     (case    6)  ;    74 

(case  10) 
Temperamental   deviations,  401 


Temporary     care,     committed     for, 

160  (case  29) 
Temporary   care   law,   41,   252,   256. 

See  Appendix  C. 
Therapy,    importance    of    diagnosis 

to,  364    (case   100) 
— variety   as,    349 
Training,  397,  545 
— through    emotions,    545 
Transfer,  of  case,  548 
Transfers  of  control,  61 
Traumatic  defect,  231    (case  49) 
Traumatic  hysteria,  117   (case  19)  ; 

340   (case  90)  ;  341    (case  91)  ; 

485  . 
Traumatic  neurosis,  86  (case  11) 
Traumatic  psychosis,  116  (case  19) 
Treitschke,  433 
Tremor,    343    (case   92) 
"Truncate"  deficiency,  96  (case  12) 
Truncated    hvpophrenia,    66    (case 

9) 
Tuberculosis,    358    (case    96)  ;    359 

(case  98) 

Tufts,  James  H.,  512 

Vacation,    164    (case  30) 
Vagrancy,  233  (case  51)  ;  294  (case 

72) 
Valentine,   Robert,  499 
"Vasomotor    neurosis,"     117     (case 

19) 

Vice,  395 

Visiting  housekeeper,   121,   164 

Vitia,  definition  of,  412 

Voltaire,  425 

Voluntary  patient,  6  (case  i)  ;  83 
(case  11);  113  (case  18);  142 
(case  25)  ;  179  (case  34)  ;  279 
(case  67) ;  300  (case  74) ;  337 
(case  89)  ;  513 

Wanderer,  352    (case  95) 

Wanderlust,   291    (case  71) 

War,  an  evil,  430 

Wayward  child,   164   (case  31) 

Welfare,  370 

White  Slave  Traffic  Commission  of 

Massachusetts,   450,  465 
Will,  lack  of,  156.      See  also  Aboulia 
Williams,  Frankwood  E.     See  Ap- 
pendix C 
Willisen,  433 
Wisdom,  superficial,  419 
"Wolf  boys,"   182    (case  35) 
Work,  interfered  with,  267 


7o8 


INDEX 


Work,  irregular,  155  (case  28)  ;  160 
(case  29)  ;  190  (case  36)  ;  308 
(case  78)  ;  342  (case  92)  ;  352 
(case  95) 

World  War,  67.    See  also  Great  War 


Worry,  195  (case  38) 
— financial,  297   (case  73) 


X-Ray,  242   (case  57)  ;  344 


DATE  DUE 

NOV    ?R  ■ 

m?. 

UNIVERSITY  PRODUCTS,  INC.    #859-5503 

BOSTON  COLLEGE 


3  9031   01511533  0 


>- 

CO 


c 

Q> 

CO 

Wi 

T- 

(0 

CM 

Q. 

o 

0) 

O 

< 

Q 

o2 

Ceco 


s 


O  -2- 


BOSTON  COLLEGE  LIBRARY 

UNIVERSITY  HEIGHTS 
CHESTNUT  HILL,  MASS. 

Books  may  be  kept  for  two  weeks   and  may  be 
renewed   for    the   same   period,  unless    reserved. 

Two  cents  a  day  is  charged  for  each  book  kept 


If  you    cannot   find    what   you   want,  ask    the 
Librarian  who  will  be  glad  to  help  you. 

The  borrower  is  responsible  for  books  drawn 
on  his  card  and  for  all  fines  accruing  on  the  same. 


